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Outcomes of Early Coronary Angiography or Revascularization After Cardiac Surgery
Journal article   Peer reviewed

Outcomes of Early Coronary Angiography or Revascularization After Cardiac Surgery

Vikram Sharma, Kevin Chen, Shehab A. R. Alansari, Beni Verma, Edward G. Soltesz, Douglas R. Johnston, Michael Zhen-Yu Tong, Eric E. Roselli, Per Wierup, Gosta B. Pettersson, …
The Annals of thoracic surgery, Vol.111(5), pp.1494-1501
05/01/2021
DOI: 10.1016/j.athoracsur.2020.06.113
PMID: 32946843

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Abstract

Background. Early coronary ischemic events are uncommon after cardiac surgery, with little known about their management or associated outcomes. We evaluated clinical outcomes of patients undergoing coronary angiography +/- percutaneous coronary intervention or redo coronary artery bypass grafting for suspected coronary ischemia within 3 weeks after index cardiac surgery. Methods. This is a retrospective observational study based on data from 53,287 patients who underwent cardiac surgery at our institution (1996-2017); 180 patients (0.34%) satisfied the inclusion criteria. The primary outcome was 1-year all-cause mortality. Statistical evaluation involved chi(2), analysis of variance, Kaplan-Meier, and receiver operating characteristic curve analyses. Results. Most coronary angiography +/- percutaneous coronary intervention and redo coronary artery bypass grafting procedures occurred in the first 2 weeks after index cardiac surgery. Patients presenting with ST elevation myocardial infarction (STEMI)/non-STEMI had the lowest 1-year mortality (13.5%), followed by patients with ventricular tachycardia/fibrillation (28.1%), and patients with non-ventricular tachycardia/fibrillation arrest or hemodynamic instability alone the worst (38.6%) (chi(2) = 17.3, P = .001). Peak troponin T level after cardiac surgery was strongly predictive of 1-year mortality (area under the curve, 0.74; 95% confidence interval, 0.65-0.84; P <.001) but did not predict the presence of coronary compromise. For acute graft failure, 1-year mortality was better with percutaneous coronary intervention (18.2%) than redo coronary artery bypass grafting (23.5%) or no indicated/feasible intervention (29.2%). Conclusions. Although suspected myocardial ischemia requiring coronary angiography or intervention early after cardiac surgery was rare, mortality was high, particularly in presentations other than STEMI/non-STEMI. In patients with overt signs and symptoms of myocardial ischemia after index cardiac surgery, troponin T was not a reliable marker of underlying coronary or graft obstruction but was a robust predictor of 1-year mortality. (C) 2021 by The Society of Thoracic Surgeons
 Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Respiratory System Science & Technology Surgery

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