The combination of increased physician experience and technological advances have produced more than a ten-fold decrease in emergency bypass surgery following angioplasty, according to an article in the October 15th rapid access issue of Circulation. It remains routine practice in the U.S. to have a surgical team on standby in case complications arise during an angioplasty procedure.

"Emergency coronary artery bypass surgery is associated with a significant risk of in-hospital complications and death," says lead author Patrick L. Whitlow, M.D.

Whitlow and his colleagues studied the medical records of 18,593 Cleveland Clinic patients who had angioplasty procedures between 1992 and 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 ten-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 anticoagulant drugs, and technological advances such as stents.

"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 noted.

In their data review, the team also determined that patients who needed emergency bypass were more likely to be female, have complex artery blockage, or be referred for angioplasty due to acute myocardial infarction.

Patients who had a prior bypass procedure, received stents, or were given platelet glycoprotein inhibitors were less likely to require emergency bypass surgery.