Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598763
Oral Presentations
Monday, February 13th, 2017
DGTHG: Coronary Heart Disease: Acute Myocardial Ischemia and Medical Therapy
Georg Thieme Verlag KG Stuttgart · New York

Impact on Mid-term Survival of Early Repeated Coronary Angiogram for Perioperative Myocardial Ischemia Following CABG: A Case-Control Study

A.R. Dakkak
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Germany, Muenster, Germany
,
M. Preusser
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Germany, Muenster, Germany
,
S. Mastrobuoni
2   Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
,
J. Landwehrt
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Germany, Muenster, Germany
,
S. Martens
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Germany, Muenster, Germany
,
A.M. Dell'Aquila
1   Department of Cardiothoracic Surgery, University Hospital Muenster, Germany, Muenster, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

 
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    Purpose: To determine the impact on survival of early coronary angiogram in patients presenting perioperative myocardial infarction (PMI) following CABG.

    Methods: Between January 2006 and October 2013, 168 of 3441 isolated CABG patients (4.9%) underwent repeated coronary angiogram because of clinical diagnosis of PMI. To ascertain the effect of PMI on late death PMI-patients were matched on the basis of age, sex and time of surgery with 336 (1:2) non PMI-patients.

    Results: Graft failure was found in 88 patients (52.4%) whereas new occlusions of native vessels occurred in 41 patients (24.4%). Thirty-nine patients (23.2%) showed normal postoperative angiogram. Revision of bypass grafts or percutaneous coronary intervention were performed in 30 (17.9%) and 59 (35.1%) patients respectively. In-hospital mortality of PMI versus non-PMI patients was 10.7% versus 1.7% (p < 000.1). After a mean follow-up time of 5.54 years, Kaplan-Meier estimator showed a survival rate of 83.4%, 77.1%, 72.5%, 62.5% in the PMI group and 96.6%, 91.9%, 87.8%, 81.1% in non PMI- group at 1, 3, 5 and 7 years respectively. After adjusting for preoperative differences, conditional Cox regression analysis revealed that independent predictors of mortality were: PMI (p < 0.001; HR 2.04), age>70 (p < 0.001; HR 3.51), reduced LVEF (p < 0.001; HR 2.9) and preoperative cerebrovascular disease (p = 0.012; HR 1.95). Cox-regression analysis among PMI patients further revealed that coronary angiogram performed >24h after surgery (p = 0.009; HR 3.4), reduced LVEF (p < 0.001; HR 6.04), and preoperative cerebrovascular disease (p = 0.04; HR 2.34), age > 70 (p = 0.02; HR 2.78), Troponin at 24h (p = 0.01; HR 1.02), and need for postoperative ECMO (p = 0.002; HR 5.53) resulted in a significantly worse survival.

    Conclusion: PMI generally results in a significantly worse in-hospital and mid-term survival outcome. However early management significantly attenuates the deleterious effects of ischemia translating in a more favorable outcome. Further prospective investigations are warranted to confirm these results and define standard treatment strategies.


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    No conflict of interest has been declared by the author(s).

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