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Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis
Fausto Biancari1,2,3, Vesa Anttila4, Angelo M Dell'Aquila5
1Department of Surgery, University of Turku, Turku, Finland. faustobiancari@yahoo.it.
Insights
Perioperative myocardial ischemia (PMI) after coronary artery bypass grafting (CABG) carries a high risk. Control angiography guides repeat revascularization, significantly reducing mortality in stable patients with PMI after CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Perioperative myocardial ischemia (PMI) following coronary artery bypass grafting (CABG) is linked to adverse patient outcomes.
- Effective management strategies for PMI post-CABG are crucial for improving survival rates.
Purpose of the Study:
- To synthesize data on the outcomes of control angiography and repeat revascularization in patients experiencing PMI after CABG.
- To evaluate the impact of diagnostic and therapeutic interventions on mortality in this patient cohort.
Main Methods:
- A comprehensive literature review was conducted using PubMed, Scopus, ScienceDirect, and Google Scholar.
- Studies published since 1990 focusing on PMI outcomes after CABG were included.
Main Results:
- Nine studies involving 1104 patients with PMI post-CABG were analyzed.
- Early mortality after reoperation for PMI without control angiography was 43.6%, with 79.8% experiencing acute graft failure.
- Among patients undergoing control angiography, 31.7% had negative findings, and 62.1% showed acute graft failure. Mortality after angiography with or without repeat revascularization was 8.9%.
Conclusions:
- Control angiography is a valuable strategy for guiding repeat revascularization in hemodynamically stable patients with PMI after CABG.
- This diagnostic approach appears to be life-saving, enabling targeted interventions and improving patient prognosis.
Background:
Perioperative myocardial ischemia (PMI) in patients undergoing coronary artery bypass grafting (CABG) is associated with poor outcome. The aim of this study was to pool the available data on the outcome after control angiography and repeat revascularization in patients with perioperative myocardial ischemia (PMI) after coronary artery bypass grafting (CABG).
Methods:
A literature review was performed through PubMed, Scopus, ScienceDirect and Google Scholar to identify studies published since 1990 evaluating the outcome of PMI after CABG.
Results:
Nine studies included 1104 patients with PMI after CABG and 1056 of them underwent control angiography early after CABG. Pooled early mortality after reoperation for PMI without control angiography was 43.6% (95%CI 29.7-57.6%) and 79.8% of them (95%CI 64.4-95.2%) had an acute graft failure detected at reoperation. Among patients who underwent control angiography for PMI, 31.7% had a negative finding at angiography (95%CI 25.6-37.8%) and 62.1% had an acute graft failure (95%CI 56.6-67.6%). Repeat revascularization was performed after early control angiography in 46.3% of patients (95%CI 39.9-52.6%; 54.2% underwent repeat surgical revascularization; 45.8% underwent percutaneous coronary intervention). Pooled early mortality after control angiography with or without repeat revascularization was 8.9% (95%CI 6.7-11.1%). Three studies reported on early mortality rates which did not differ between repeat surgical revascularization and PCI (11.7% vs. 9.2%, respectively; risk ratio 1.45, 95%CI 0.67-3.11). In these three series, early mortality after conservative treatment was 5.9% (95%CI 3.6-8.2%).
Conclusions:
Control angiography seems to be a valid life-saving strategy to guide repeat revascularization in hemodynamically stable patients suffering PMI after CABG.
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