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Coronary Angiography Within 30 Days From Coronary Artery Bypass Graft Surgery: Indications, Findings, and Outcomes
Bahadir Simsek, Beatrice D Rynders, Brynn K Okeson
1Minneapolis Heart Institute Foundation, 920 E 28th Street #300, Minneapolis, MN 55407 USA. esbrilakis@gmail.com.
Insights
Coronary angiography (CAG) within 30 days of coronary artery bypass graft (CABG) surgery occurs in 5% of patients. These patients face high complication rates, including 26% readmission and 17% mortality within 30 days.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Limited data exists on the incidence, indications, and outcomes of early coronary angiography (CAG) after coronary artery bypass graft (CABG) surgery.
- Investigating these early post-CABG CAG procedures is crucial for understanding patient management and outcomes.
Approach:
- A retrospective review was conducted on 2209 patients who underwent CABG between April 2018 and September 2021.
- 111 patients (5%) who had CAG within 30 days post-CABG were analyzed for demographics, indications, interventions, and outcomes.
Key Points:
- The primary indications for early CAG included cardiogenic shock (41%), ST-elevation myocardial infarction (32%), and assessment for complete revascularization (16%).
- Graft occlusion rates were significant: 44% for LIMA, 42% for RIMA, and 50% for SVG.
- Half of the patients (50%) underwent percutaneous coronary intervention (PCI), with most targeting native vessels (85%). Repeat sternotomy was performed in 17% of patients.
Conclusions:
- The incidence of CAG within 30 days post-CABG is approximately 5%.
- Patients undergoing early CAG after CABG exhibit high rates of complications, with 26% readmission and 17% mortality at 30 days.
Background:
The incidence, indications, and outcomes of coronary angiography (CAG) performed within 30 days following coronary artery bypass graft surgery (CABG) have received limited study.
Methods:
We reviewed patients who underwent CAG within 30 days following CABG between April 2018 and September 2021 at a large quaternary healthcare system.
Results:
Of 2209 patients who underwent CABG during the study, 111 (5%) underwent CAG within 30 days following CABG. Mean age was 65 ± 10 years and they had high prevalence of comorbidities. Graft utilization was as follows: left internal mammary artery (LIMA) (84%); saphenous vein graft(s) (SVG) (81%); and right internal mammary artery (RIMA) (22%). The most common presentations/indications for angiography were cardiogenic shock (41%), ST-segment-elevation myocardial infarction (32%), and achieving complete revascularization by percutaneous coronary intervention (PCI) (16%). The LIMA, RIMA, and SVGs were completely/partially occluded in 41 (44%), 10 (42%), and 11 (50%) of patients, respectively. Of the 111 patients who underwent CAG, 55 (50%) underwent PCI, including 47 (85%) to the native vessel and 8 (15%) to the bypass graft, and 19 (17%) underwent repeat sternotomy. Overall, 29 patients (26%) required 30-day readmission following CAG and 19 (17%) died.
Conclusion:
The incidence of CAG within 30 days following CABG is approximately 5%. Patients who need CAG following CABG have high complication rates (26% readmission and 17% mortality, respectively, at 30 days).
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