Use of internal mammary artery for emergency grafting after failed coronary angioplasty.

Of 929 consecutive patients who underwent percutaneous transluminal coronary angioplasty over a 36-month period, 32 (3.4%) had emergency coronary artery bypass grafting for angioplasty failure. Twenty-two patients (69%) were hemodynamically stable (stable group), and 10 (31%) were unstable (unstable group) before emergency bypass. In the unstable group, the interval between failed angioplasty and opening of the grafts or end of extracorporeal circulation was significantly shorter (p < 0.001 and p < 0.002, respectively) and significantly more grafts per patient were performed (p < 0.05) than in the stable group. Twenty-seven patients (84%) received at least one internal mammary artery graft, independent of their hemodynamic condition. In 11 culprit left anterior descending arteries, the internal mammary artery graft was supplemented by a saphenous vein graft to the same territory, especially in the unstable group. There were no hospital deaths. Postoperatively, the incidence of myocardial infarction (p < 0.005) and the use of antiarrhythmics (p < 0.0001) were increased and length of stay tended to be longer in the unstable compared with the stable group. The use of a reperfusion catheter had no influence on clinical outcome, except for a significantly reduced postoperative use of antiarrhythmics (p < 0.05). The internal mammary artery can be used in emergency coronary artery bypass grafting after failed percutaneous transluminal coronary angioplasty, without hospital mortality and with acceptable morbidity, especially in hemodynamically stable patients.