Coronary graft patency after perioperative myocardial infarction: a study with multislice computed tomography
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Published on: March 27, 2018
Hosseinali Bassiri1, Alireza Nematollahi, Fereidoun Noohi
1Department of Interventional Cardiology, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Multislice computed tomography angiography (MSCT) effectively assesses graft patency after coronary artery bypass grafting (CABG). Graft occlusion, linked to hyperglycemia and severe distal disease, contributes to perioperative myocardial infarction (MI).
Area of Science:
- Cardiovascular Surgery
- Radiology
- Cardiology
Background:
- Perioperative myocardial infarction (MI) is a serious complication following coronary artery bypass grafting (CABG).
- Assessing graft patency is crucial for understanding the causes of perioperative MI.
Purpose of the Study:
- To evaluate the feasibility of multislice computed tomography (MSCT) angiography for assessing graft patency in patients experiencing perioperative MI after CABG.
- To identify factors associated with graft occlusion and perioperative MI.
Main Methods:
- A study of 55 consecutive patients who had perioperative MI post-CABG.
- Utilized multislice computed tomography (MSCT) angiography to assess coronary artery bypass graft patency.
Main Results:
- MSCT detected acute graft occlusion in 23% of grafts.
- 40% of patients with perioperative MI had occluded grafts, often associated with hyperglycemia and severe distal disease.
- In patients with patent grafts, native vessel stenosis was a key factor in perioperative MI.
Conclusions:
- MSCT is a feasible imaging modality for evaluating graft patency in the context of perioperative MI.
- Graft occlusion is a significant factor in perioperative MI, particularly in patients with hyperglycemia and severe distal coronary artery disease.
- Native vessel stenosis is a primary risk factor for perioperative MI in cases with patent grafts.
Abstract:
A total of 55 consecutive patients who experienced perioperative myocardial infarction (MI) after coronary artery bypass grafting were studied using multislice computed tomography (MSCT) angiography to evaluate for graft patency. The MSCT detected acute graft occlusion in 23% grafts. Of the 55 patients, 40% patients had occluded grafts and perioperative MI in the area of the grafted vessels; remaining 60% had patent grafts with infarction in the area of the grafted vessels. Compared with the patients with patent grafts, those with occluded grafts had a higher blood sugar level. In addition, graft occlusion was higher in grafts with severe distal disease. Among the patients with patent grafts, luminal stenosis of the native vessels supplying the infarcted myocardium was higher than that in the native vessels supplying the non-infarcted myocardium. In conclusion, MSCT is feasible for the assessment of graft patency in the setting of perioperative MI. Graft occlusion is detected in less than half of the cases and usually occurs in the grafts with severe distal involvement and the patients with uncontrolled hyperglycemia. In patients with patent grafts, the severity of luminal stenosis of the native grafted vessel is the main predisposing factor for perioperative MI.
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