Operative Procedures Not Involving the Heart After Percutaneous Transluminal Coronary Angioplasty

The benefit of coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) who require extensive surgical procedures not involving the heart has been established. During the past decade, percutaneous transluminal coronary angioplasty (PTCA) has been developed as an alternative therapy to CABG for patients with CAD. In an attempt to determine the safety of other surgical procedures after PTCA, we retrospectively reviewed 148 patients who underwent 193 surgical procedures from four to 1,867 days after PTCA for CAD. Seventy-two patients had surgical treatment within 90 days of PTCA. Thirty-five patients had CABG prior to PTCA, and 113 had PTCA as the initial treatment for CAD. Four patients died postoperatively, only one death was cardiac in origin. One patient had a myocardial infarction postoperatively (the one cardiac death). Fifteen patients had other cardiac complications (nine patients with arrhythmias and six with myocardial ischemia). Patients operated upon within 90 days of PTCA had no increased cardiac morbidity, although the one myocardial infarction occurred in this group. No difference in cardiac morbidity occurred in patients with multivessel CAD treated by PTCA compared with single vessel disease. However, patients more than 60 years of age had more cardiac problems (16 of 110) than those less than 60 years of age (zero of 38) (p = 0.01). Treatment of CAD by PTCA protects the myocardium from fatal cardiac events and myocardial infarction during subsequent noncardiac operative procedures even early (less than 90 days) in the post-PTCA period. Older patients seem to be at higher risk, however, for nonfatal cardiac complications.