Impact of coronary angiography early after CABG for suspected postoperative myocardial ischemia
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(2019) 14:54
RESEARCH ARTICLE
Open Access
Impact of coronary angiography early after CABG for suspected postoperative myocardial ischemia Leopold Rupprecht1* , Christof Schmid1, Kurt Debl2, Dirk Lunz3, Bernhard Flörchinger1 and Andreas Keyser1
Abstract Background: The incidence of perioperative myocardial infarction is reported to 2–8%. The aim of the study (retrospectively registered) was to evaluate whether control coronary angiography after surgery is useful in case of suspected postoperative myocardial ischemia. Methods: All patients who demonstrated signs of myocardial ischemia post CABG and underwent coronary angiography from 6/2008 to 06/2015 were retrospectively analyzed. Myocardial ischemia post CABG was defined as an increase of CK/CK-MB, occasionally associated with arrhythmias or low output syndrome. Results: Overall, 108 patients (age 66 ± 9 years) demonstrated signs of myocardial ischemia post CABG and underwent coronary angiography corresponding to an incidence of 2.2%. Of them, 70 patients (65%) demonstrated graft pathologies. A therapeutic consequence was drawn in 62 Patients (57%), which consisted of redo surgery in 10 patients (9%) and PCI with stent placement in 52 patients (48%). Of the remaining 46 patients, 29 patients showed intact bypass grafts (27%), whereas 17 patients had minor pathologies (16%). Demographic data including the extent of the coronary artery disease, urgency of operation, comorbidities, EuroScore, surgical technique, postoperative lab tests and transfusion requirements were comparable among the groups. Redo surgery patients had prior PCI in 33% of patients, which was much higher than in the other groups. Patients with reintervention had a 30d-mortality rate of 13%, conservatively treated patients only 2.2%. Mortality was highest after redo surgery with 25%. Conclusions: Postoperative coronary angiography is a useful tool with a significant therapeutic value. Pathological findings mandate further revascularization therapy in roughly half of the patients. PCI is a safe choice in the majority of patients, redo surgery is much less indicated. Keywords: Coronary bypass surgery (CABG), Myocardial infarction, Coronary angiography
Background Over the past decades and along with the numerous achievements in percutaneous coronary intervention, the patients referred for surgical revascularization progressively present with devastating coronary findings. The coronary artery bypass operation is the treatment of choice in advanced coronary artery disease, but cannot always guarantee complete revascularization in these patients with extreme calcifications and numerous stenotic lesions or coronary occlusions. As a consequence, * Correspondence: [email protected] 1 Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany Full list of author information is available at the end of the article
the risk of perioperative myocardial infarction, which is reported to 2–8%, and the threat of bypass graft occlusi
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