Rate of Urgent Coronary Artery Bypass Grafting in Elective Percutaneous Coronary Intervention (PCI)

background: latest research shows that about 0.5% of percutaneous coronary intervention (pci) patients will need urgent coronary artery bypass grafting (cabg) because of coronary accidents. the acc/aha guidelines regard on-site cardiac surgery back-up obligatory for pci centers. it seems the need for urgent cabg in some iranian pci centers is less than 0.5%, which may affect decision-making for performing pci without on-site surgical back-up in the same condition in iran.methods: this retrospective study reviewed all elective pci documents in two large educational centers with on-site cardiac surgery back-up in tehran from april 2005 to april 2006. cabg immediately after pci or until 24 hours after pci was considered urgent.results: there were 1533 pci patients (71% male) and 1936 pci vessels in our study. the patients’ mean age was 56 (95% ci 46-66) years. the prevalence of hypertensives, smokers, and diabetics was 42%, 44%, and 24%, respectively. the mean stenotic lesion length was 20.5 mm (95% ci 19.5-21), and the mean lesion diameter was 3.02 mm (95% ci 2.58–3.52). there were 98 (5.8%) unsuccessful pci procedures. the relative frequency of pci on different vessels was 1070 (55%) on the left anterior descending artery (lad), 591(30.5%) on the proximal part of lad, 286 (14.5%) on left circumflex artery (lcx), 438 (22%) on the right coronary artery (rca), and 142 (7.2%) on other arteries such as the obtuse marginal (om) or diagonal arteries. there was only one case of urgent cabg in these patients.conclusion: the recent widespread use of coronary stenting, new antiplatelet drugs, and increased skills of operators has ushered in a considerable reduction in urgent cabg after pci.