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Updated: Aug 9, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Outcomes After Early Postoperative Myocardial Infarction Due to Graft Failure in Patients Undergoing Coronary Artery
Heike Baumgarten, A Rolf, Maren Weferling
1University Hospital Frankfurt, Department of Cardiac Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. mani.arsalan@kgu.de.
Insights
Early graft failure after coronary artery bypass grafting is often undetected but significantly increases mortality. Prompt coronary angiography and treatment are crucial for patients with suspected early graft failure to improve outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Early graft failure (EGF) after coronary artery bypass grafting (CABG) affects up to 12% of grafts and can lead to perioperative myocardial infarction and increased mortality.
- EGF is often clinically silent, making early detection and intervention challenging.
Purpose of the Study:
- To determine the incidence of clinically apparent EGF in patients undergoing CABG.
- To analyze the impact of EGF on 30-day mortality after CABG.
Main Methods:
- Retrospective analysis of consecutive patients undergoing CABG between January 2015 and December 2018.
- Evaluation of patients who underwent emergency coronary angiography (CAG) for suspected EGF, comparing their outcomes to a matched control group without EGF.
Main Results:
- 1.5% of patients (86/5638) underwent emergency CAG for suspected EGF.
- Clinically apparent EGF was confirmed in 70.9% of these patients.
- The 30-day mortality rate for patients with suspected EGF undergoing CAG was 22.4%, significantly higher than the overall 2.8% mortality rate.
Conclusions:
- Clinically apparent EGF is an independent predictor of mortality following CABG.
- Emergency CAG and timely intervention are essential for managing suspected EGF and improving patient survival.
- The high mortality associated with EGF underscores the need for vigilant monitoring and prompt management.
Background:
Early graft failure (EGF) after coronary artery bypass grafting (CABG) occurs in up to 12% of grafts, but is often clinically unapparent. EGF may result in perioperative myocardial infarction with consequently increased mortality. The aim of the present study was to analyze the incidence of clinically apparent EGF in patients undergoing CABG and the influence on mortality.
Methods:
We analyzed outcomes of consecutive patients undergoing CABG from January 2015 to December 2018 with respect to postoperative emergency coronary angiography (CAG) due to suspected EGF and 30-day mortality. Patients with CAG-documented EGF were matched to patients without EGF to examine predictors of mortality.
Results:
The analysis included 5638 patients undergoing CABG. Eighty-six patients (1.5%) underwent emergency CAG due to suspected EGF. Clinically apparent EGF was observed in 61 of these patients (70.9%), whereas 14 (16.3%) had a culprit lesion in a native coronary artery. The majority of patients (n = 45; 52.3%) were treated with percutaneous coronary intervention and 31 (36%) underwent re-do CABG. The remaining patients were treated conservatively. The 30-day mortality rate of suspected EGF patients undergoing CAG was 22.4% (n = 19), which was higher than the mortality rate of 2.8% overall (P<.001); this remained higher after matching the EGF patients with the control group (11 [20.4%] vs 2 [4.0%]; P=.02).
Conclusion:
Emergency CAG after CABG is rare and is primarily carried out in patients with EGF. The 30-day mortality rate of these patients is high, and EGF is an independent predictor of mortality. Perioperative CAG with subsequent treatment is mandatory in these patients.
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