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May 1, 2019Open HeartOpen Access

Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery

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Key result

Perioperative myocardial ischemia after CABG was associated with a 30-day mortality of 9% compared to 1.4% overall, while urgent PCI for early graft failure preserved postoperative LVEF.

Why the study?

Updated knowledge regarding perioperative myocardial ischaemia after CABG and the treatment of acute graft failure was needed.

Does urgent percutaneous coronary intervention improve outcomes compared to emergency reoperation or conservative management in patients with suspected perioperative myocardial ischaemia after CABG?

Population

43 of 1119 consecutive patients undergoing isolated CABG who had suspected perioperative MI

Comparison

Emergency reoperation vs acute PCI vs conservative treatment

Design

Retrospective analysis of prospectively collected data

Follow-up

30 days

Authors

DSDavorin SefJSJanko Szavits-NossanMPMladen Predrijevac

Discussion

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Overview

Urgent PCI may preserve LVEF versus reoperation in post-CABG ischemia; hypothesis-generating and requires randomized confirmation before practice change.

Key Points

  • The aim is to understand factors linked to perioperative myocardial ischaemia and evaluate treatment strategies following graft failure.
  • Analyzed data from 1119 patients who underwent isolated CABG between January 2011 and December 2015.
  • Urgent coronary angiography was performed on 43 patients suspected of perioperative myocardial ischaemia.
  • Primary endpoint was 30-day mortality, while secondary endpoints included postoperative left ventricular ejection fraction and major adverse cardiac events.
  • 30-day mortality was 1.4% in CABG patients, compared to 9% in those with perioperative myocardial ischaemia (4 patients).
  • Postoperative left ventricular ejection fraction significantly decreased in the redo group (45% post-op vs 53% pre-op).
  • Angiography revealed causes such as incorrect graft anastomosis and acute coronary artery thrombotic occlusion.

Study Design

Type

Observational (n=1,119)

Structured PICO

Does urgent percutaneous coronary intervention improve outcomes compared to emergency reoperation or conservative management in patients with suspected perioperative myocardial ischaemia after CABG?

P
Population
1119 consecutive patients with coronary artery disease who underwent isolated CABG, with a focus on 43 patients (3.8%) who underwent urgent coronary angiography due to suspected perioperative myocardial ischaemia.
I
Intervention
Urgent coronary angiography followed by acute percutaneous coronary intervention (PCI) (n=15)
C
Comparator
Emergency reoperation (Redo) (n=14) or conservative treatment (Non-op) (n=14)
O
Outcome
30-day mortalityhard clinical

Main Result

Absolute Event Rate: 9% vs 1.4%

Urgent coronary angiography and PCI for suspected perioperative myocardial ischaemia after CABG preserves left ventricular ejection fraction compared to emergency reoperation.

Cite This Study

Sef et al. (2019) conducted an observational in Coronary artery disease undergoing isolated CABG (n=1,119). Urgent coronary angiography and treatment (PCI, reoperation, or conservative) vs. Overall CABG cohort was evaluated on 30-day mortality. Perioperative myocardial ischemia after CABG was associated with a 30-day mortality of 9% compared to 1.4% overall, while urgent PCI for early graft failure preserved postoperative LVEF.

synapsesocial.com/papers/6a18dd41c9d74cf65281fbb2https://doi.org/10.1136/openhrt-2019-001027
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Impact of Expeditious Management of Perioperative Myocardial Ischemia in Patients Undergoing Isolated Coronary Artery Bypass Surgery2013 · 56 citations
  2. 2Angiography for Management of Perioperative Myocardial Ischemia: Does it Have Any Role?2014 · 6 citations
  3. 3Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis2018 · 26 citations
  4. 4Trends in mortality risks among 94,328 patients surviving 30 days after a first isolated coronary artery bypass graft procedure from 1987 to 2006: A population-based study2017 · 21 citations
  5. 5The impact of intraoperative transit time flow measurement on the results of on-pump coronary surgery2007 · 57 citations