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Acute coronary angiography after coronary artery bypass grafting
Karin Hultgren1, Anders Andreasson1, Tomas A Axelsson2
1a Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden ;
Insights
Acute coronary angiography after coronary artery bypass grafting (CABG) is rare but associated with higher mortality. Early detection of myocardial ischemia is crucial for patient outcomes following CABG surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Coronary angiography is the gold standard for diagnosing myocardial ischemia post-coronary artery bypass grafting (CABG).
- This study reviews the experience with acute coronary angiography following CABG.
Purpose of the Study:
- To assess the incidence, indications, findings, and outcomes of acute coronary angiography after CABG.
- To compare outcomes between patients who underwent angiography and those who did not.
Main Methods:
- Retrospective observational study of 4446 patients undergoing CABG between 2007 and 2012.
- Analysis of patient demographics, indications for angiography, diagnostic findings, and mortality rates.
Main Results:
- Acute coronary angiography was performed in 2% of patients, often indicated by ECG changes, echocardiographic alterations, hemodynamic instability, angina, or arrhythmia.
- Positive findings were detected in 69% of cases, with ECG changes showing moderate association with positive findings, increasing with additional ischemic signs.
- Patients undergoing angiography had higher 30-day mortality (7% vs. 2%) and lower five-year survival (77% vs. 87%).
Conclusions:
- Acute coronary angiography is an infrequent but significant event after CABG.
- Postoperative myocardial ischemia requiring acute angiography is linked to 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.
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