Peri-procedural myocardial infarction requiring angiography occurred in 2% of post-cardiac surgery patients with a 16% mortality rate; conservative management was associated with the lowest mortality.
Meta-Analysis (n=104,445)
Does the choice of management strategy (conservative, PCI, or reperforming surgery) affect mortality in post-cardiac surgery patients with peri-procedural myocardial infarction requiring urgent coronary angiography?
In patients with peri-procedural myocardial infarction after cardiac surgery, conservative management and PCI are associated with lower mortality risks compared to reperforming surgery, though a significant proportion of patients have no angiographic abnormalities.
Introduction: Peri-procedural myocardial infarction (PMI) after cardiac surgery is a significant yet often under-recognised complication, sometimes necessitating urgent coronary angiography (PMI-rCA). This meta-analysis evaluates its prevalence, angiographic findings, management strategies, and associated mortality. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Data from nine studies comprising 104,445 post-cardiac surgery patients were analysed. Among them, those undergoing PMI-rCA were categorised by treatment strategy: conservative management, percutaneous coronary intervention (PCI), or reperform surgery. A network meta-analysis compared mortality risks across these groups, with findings visualised using forest plots, network diagrams, and SUCRA rankings. Results: PMI-rCA was performed in 1205 patients (2%). Of these, 34.3% had no significant angiographic abnormalities, 53.7% exhibited graft failure, and 10.4% had native vessel ischemia. Management strategies included conservative treatment (55.5%), PCI (23.5%), and reperforming surgery (21%). Network meta-analysis indicated that conservative management was associated with the lowest mortality risk, followed by PCI, while reperforming surgery had the highest risk. Discussion: These findings highlight the complexity of PMI diagnosis and treatment. The high proportion of patients without significant angiographic abnormalities raises concerns about potential overuse of invasive procedures. Meanwhile, PCI appears to be a more favourable interventional strategy than reperforming surgery in terms of mortality outcomes. Conclusions: PMI requiring coronary angiography is uncommon but clinically significant, with a 16% mortality rate. A tailored, risk-based approach is essential to optimise management, balancing conservative therapy, PCI, and reperforming surgery based on individual patient profiles.
Cereda et al. (Tue,) conducted a meta-analysis in Peri-procedural myocardial infarction after cardiac surgery (n=104,445). Coronary angiography and subsequent management (conservative, PCI, or reperform surgery) vs. Network comparison between conservative management, PCI, and reperform surgery was evaluated on Mortality. Peri-procedural myocardial infarction requiring angiography occurred in 2% of post-cardiac surgery patients with a 16% mortality rate; conservative management was associated with the lowest mortality.