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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
09:12

Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery

Published on: March 27, 2018

Indications for angiography subsequent to coronary artery bypass grafting

Peter Alter1, Sebastian Vogt, Matthias Herzum

  • 1Department of Internal Medicine-Cardiology, Philipps University of Marburg/Lahn, Marburg, Germany. palter@mailer.uni-marburg.de <palter@mailer.uni-marburg.de>

American Heart Journal
|June 25, 2005
PubMed

Insights

Early detection of myocardial infarction after coronary artery bypass grafting (CABG) is crucial. Elevated leukocyte counts and CK-MB levels, along with ST elevation, can help identify graft failure or vessel occlusion, guiding timely intervention.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Biomarkers
  • Diagnostic Imaging

Background:

  • Postoperative myocardial infarction (MI) is a rare but serious complication following coronary artery bypass grafting (CABG).
  • Timely identification of coronary bypass graft failure or native vessel occlusion is essential to prevent significant myocardial damage.

Purpose of the Study:

  • To evaluate early diagnostic markers for myocardial infarction after CABG.
  • To determine the utility of specific biomarkers and ECG findings in detecting graft or vessel issues post-CABG.

Main Methods:

  • Assessed 1000 patients undergoing CABG, with 40 receiving postoperative coronary angiography for suspected ischemia.
  • Measured creatine kinase (CK), CK-MB, leukocyte count, C-reactive protein (CRP), lactate dehydrogenase (LDH), and glutamate-oxalacetate transaminase (GOT) at multiple time points.
  • Utilized 12-lead standard electrocardiography (ECG) to assess for ischemic changes.

Main Results:

  • Postoperative angiography revealed graft failure or occluded vessels in 32.5% of patients with suspected MI.
  • Elevated leukocyte counts immediately post-CABG and increased CK-MB concentrations at 6 hours were significantly associated with graft/vessel occlusion.
  • ST-segment elevation on ECG was more frequent in patients with ischemia.

Conclusions:

  • Traditional MI diagnostic criteria are often insufficient after CABG.
  • A combination of elevated leukocytes (>14,000 G/L at hour 0) and either ST elevation or CK-MB >35 U/L (at hour 6) appears useful for detecting MI post-CABG.
  • Elevated CK-MB (>70 U/L at hour 6) alone may predict ischemia, warranting angiography and potential revascularization.
Abstract

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