Early angiographic control of perioperative ischemia after coronary arterybypass grafting

Objective: To assess the impact of immediate angiography in patients with d efined clinical and laboratory criteria of perioperative myocardial infarct ion after coronary artery bypass operation. Patients and methods: Between J anuary 1999 and December 1999 2052 patients underwent coronary artery bypas s grafting in our institution. Out of this cohort 131 (6.4%) patients met t he criteria of perioperative myocardial ischemia, which was defined as: (a) increase in the isoenzyme ratio of creatinine phosphokinase (CK/CK-MB) abo ve 10%; (b) ischemic electrocardiographic episodes (defined as a new onset of elevated ST-segment change lasting at least 1 min and involving a shift from baseline of greater than or equal to 0.1 mV of ST-depression and a new association of a postoperative Q; (c) recurrent episodes of, or sustained ventricular tachyarrhythmia as well as ventricular fibrillation; (d) hemody namic deterioration despite adequate inotropic support. Results: Angiograph y was performed in 108 patients: (5.3%, group A) whereas 23 patients (1.1%, group B) were immediately re-operated due to severely compromised hemodyna mics. Angiographic results in group A showed regular grafts in 45 patients (2.2%); 63 patients (3.1%) had either an occlusion (n = 41), incorrect anas tomosis (n = 29), graft stenosis (n = 14), graft spasm (n = 6), displaced g raft (n = 6), poor distal run-off (n = 5) or incomplete revascularization ( n = 2). In group A 43 patients underwent a re-operation (34 patients) or an early angioplasty (nine patients). Due to poor coronary artery status no i ntervention was performed in the remaining 20 patients with angiographic fi ndings. Operative findings in group B showed graft occlusion in ten patient s (43.5%), incorrect anastomosis in five patients (21.7%), bleeding, stretc hed graft, venous graft spasm and displaced graft in one patient (4.3%) eac h, and no patho-morphological finding in 4 patients (17.4%). Thirty-day mor tality rate was ten patients in group A (9.3%), all of them with angiograph ic findings, as opposed to nine patients (39.1%) in group B. Conclusion: ST -change and elevated CK/CK-MB enzyme ratio is highly indicative for possibl e graft failure and should be followed early angiographic control to assess the need for reintervention. (C) 2001 Elsevier Science B.V. All rights res erved.