It is routine to have a surgical team on standby in case complications arise during an angioplasty procedure. Angioplasty involves the insertion of a balloon-tipped catheter into a narrowed artery then inflating the balloon to reopen the vessel.
"Emergency coronary artery bypass surgery is associated with a significant risk of in-hospital complications and death," says study author Patrick L. Whitlow, director of interventional cardiology at the Cleveland Clinic Foundation in Cleveland.
Whitlow and his colleagues studied the medical records of 18,593 Cleveland Clinic patients who had angioplasty procedures to open narrowed heart arteries from 1992 - 2000.
"We found a significant decline in the prevalence of emergency bypass surgery, from 1.5 percent in 1992 to 0.14 percent in 2000 - more than a 10-fold decline," Whitlow says. "The data suggest that the overall safety of angioplasty has dramatically improved in the last decade."
The researchers attribute the decline to several factors including greater physician experience, improved techniques, new drugs to inhibit clot formation, and technological advances such as stents, which help keep arteries open.
"Among the patients who did not require emergency bypass surgery, there was a significant decline in the incidence of death and heart attacks from 1992 through 2000," Whitlow says.
Researchers also found that patients who needed emergency bypass were more likely to be female, have complex artery blockage, or be undergoing angioplasty because of a heart attack.
Patients who had a prior bypass operation, received stents or were given anti-clotting drugs called platelet glycoprotein inhibitors were less likely to require emergency bypass surgery.
Co-authors are Niranjan Seshadri, M.D.; Naveen Acharya, M.D.; Penny Houghtaling; Eugene H. Blackstone, M.D.; and Stephen G. Ellis, M.D.
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