Cardiac Ischemic Complications Following Cardiac Surgery - Angiographic Findings and Predictors of In-hospital Mortality

Objective: To describe findings and predictors of in-hospital mortality in patients requiring repeated coronary angiogram for cardiac ischemic complications following heart surgery.

Methods: Between January 2005 and January 2015, out of 10,759 (3.1%) 336 patients underwent postoperative coronary angiogram because clinical signs of cardiac ischemia occurred. Operative procedures included CABG in 294 patients, 84 valve and 14 aortic procedures. A logistic regression analysis was performed to identify significant risk factors for in-hospital mortality.

Results: Graft failure including distal anastomotic stenosis, kinking or graft thrombosis was found in 121 angiograms (36%). A new native coronary artery occlusion was found in 96 patients (28.6%). A combination of graft-related and non-graft-related occlusions occurred in 36 patients (10.7%), while 83 patients (24.7%) had normal postoperative graft-related angiograms. Revision CABG and percutaneous coronary intervention was performed in 56 (16.7%) and 120 (35.7%) patients respectively. In hospital mortality was 15.8% (53 patients). After multivariate adjustment emergency admission (p< 0.0001; OR 5.3), absence of preoperative sinus rhythm (p = 0.006; OR 3.2), female sex (p = 0.007; OR 2.7), aortic valve surgery (p = 0.01; OR 2.8), aortic surgery (0.01; OR 2.8), history of decompensation (p = 0.02; OR 2.9) and surgery duration (p = 0.04; OR 1.004) turned out to be independent predictors of in hospital mortality.

Conclusion: Postoperative ischemic heart complications with the need of re-coronary angiogram generally results in a notably bad outcome in terms of mortality. Patients with abovementioned risk factors for mortality deserve particular care and expertise to avoid ischemic complications.