Karin Hultgren1, Anders Andreasson1, Tomas A Axelsson2, Per Albertsson3, Vincenzo Lepore1, Anders Jeppsson1,4. 1. a Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden ; 2. b Faculty of Medicine , Landspitali University Hospital, University of Iceland , Reykjavik , Iceland ; 3. c Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden ; 4. d Department of Molecular and Clinical Medicine , Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
Abstract
OBJECTIVES: Coronary angiography is the golden standard when myocardial ischemia after CABG occurs. We summarize our experience of acute coronary angiography after CABG. DESIGN: All 4446 patients (mean age 68 ± 9 years, 22% women) who underwent CABG 2007 to 2012 were included in this retrospective observational study. Incidence, indications, findings, measures of acute angiography after CABG was assessed. Outcome variables were compared between patients who underwent angiography and those who did not. RESULTS: Eighty-seven patients (2%) underwent acute coronary angiography. Patients undergoing angiography had ECG changes (92%), echocardiographic alterations (48%), hemodynamic instability (28%), angina (15%), and/or arrhythmia (13%). Positive findings were detected in 69% of the cases. Only ECG changes as indication for angiography had a moderate association with positive findings, but the precision increased if other sign(s) of ischemia were present. Thirty-day mortality (7% versus 2%, p = 0.002) was higher and long-term-cumulative survival lower (77% versus 87% at five years, p = 0.043) in angiography patients. CONCLUSIONS: Acute angiography is a rare event after CABG. Postoperative myocardial ischemia leading to acute coronary angiography is associated with increased short-term and long-term mortality.
OBJECTIVES: Coronary angiography is the golden standard when myocardial ischemia after CABG occurs. We summarize our experience of acute coronary angiography after CABG. DESIGN: All 4446 patients (mean age 68 ± 9 years, 22% women) who underwent CABG 2007 to 2012 were included in this retrospective observational study. Incidence, indications, findings, measures of acute angiography after CABG was assessed. Outcome variables were compared between patients who underwent angiography and those who did not. RESULTS: Eighty-seven patients (2%) underwent acute coronary angiography. Patients undergoing angiography had ECG changes (92%), echocardiographic alterations (48%), hemodynamic instability (28%), angina (15%), and/or arrhythmia (13%). Positive findings were detected in 69% of the cases. Only ECG changes as indication for angiography had a moderate association with positive findings, but the precision increased if other sign(s) of ischemia were present. Thirty-day mortality (7% versus 2%, p = 0.002) was higher and long-term-cumulative survival lower (77% versus 87% at five years, p = 0.043) in angiography patients. CONCLUSIONS: Acute angiography is a rare event after CABG. Postoperative myocardial ischemia leading to acute coronary angiography is associated with increased short-term and long-term mortality.
Authors: Fausto Biancari; Vesa Anttila; Angelo M Dell'Aquila; Juhani K E Airaksinen; Debora Brascia Journal: J Cardiothorac Surg Date: 2018-02-27 Impact factor: 1.637