Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis

Abstract

BackgroundPerioperative myocardial ischemia (PMI) in patients undergoing coronary artery bypass grafting (CABG) is associated with poor outcome. The aim of this study was to pool the available data on the outcome after control angiography and repeat revascularization in patients with perioperative myocardial ischemia (PMI) after coronary artery bypass grafting (CABG).MethodsA literature review was performed through PubMed, Scopus, ScienceDirect and Google Scholar to identify studies published since 1990 evaluating the outcome of PMI after CABG.ResultsNine studies included 1104 patients with PMI after CABG and 1056 of them underwent control angiography early after CABG. Pooled early mortality after reoperation for PMI without control angiography was 43.6% (95%CI 29.7-57.6%) and 79.8% of them (95%CI 64.4-95.2%) had an acute graft failure detected at reoperation. Among patients who underwent control angiography for PMI, 31.7% had a negative finding at angiography (95%CI 25.6-37.8%) and 62.1% had an acute graft failure (95%CI 56.6-67.6%). Repeat revascularization was performed after early control angiography in 46.3% of patients (95%CI 39.9-52.6%; 54.2% underwent repeat surgical revascularization; 45.8% underwent percutaneous coronary intervention). Pooled early mortality after control angiography with or without repeat revascularization was 8.9% (95%CI 6.7-11.1%). Three studies reported on early mortality rates which did not differ between repeat surgical revascularization and PCI (11.7% vs. 9.2%, respectively; risk ratio 1.45, 95%CI 0.67-3.11). In these three series, early mortality after conservative treatment was 5.9% (95%CI 3.6-8.2%).ConclusionsControl angiography seems to be a valid life-saving strategy to guide repeat revascularization in hemodynamically stable patients suffering PMI after CABG.

Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery

“…Overall 30-day mortality in our study was comparable or even less than in recently published studies 2 8 10 19 20. In a recently published meta-analysis that included 1104 patients with perioperative MI after CABG, overall 30-day mortality was 8.9% 19. Furthermore, Preußer et al analysed mid-term results and reported survival rates at 7 years of 62.5% in the perioperative MI group and 81.1% in non-perioperative MI group 20…”

Diagnosis of Myocardial Infarction After Noncardiac Surgery: Results of a National Survey in Russia

“…Although control coronary angiography appears to be a valid life-savingÀguiding strategy for repeat revascularization in hemodynamically stable patients who develop a PMI after coronary artery bypass grafting, its safety and efficacy in terms of improving the short-and long-term outcomes of patients after noncardiac surgery should be determined in future studies. 12,13 The majority of responders (82%) also used clinical guidelines to reduce the rate of postoperative cardiovascular complications, although the quality of the majority of these recommendations was not strong. 10 The compelling evidence of the negative effect of PMI on short-and long-term morbidity and mortality after noncardiac surgery and the results of our survey suggest that several organizational steps should be undertaken in Russia.…”

MRI tracing of ultrasmall superparamagnetic iron oxide nanoparticle‑labeled endothelial progenitor cells for repairing atherosclerotic vessels in rabbits

“…Moreover, atherosclerosis remains a major cause of long-term morbidity and mortality worldwide as it is a prerequisite to a large number of cardiovascular diseases (CVDs) ( 2 ); for example, the prevalence of CVDs was predicted to reach 43.9% in the United States in 2030 ( 3 ), and in 2015 alone, 17.7 million people died from CVD worldwide ( 4 ). While a coronary artery bypass graft is widely performed for the revascularization of occluded vessels, it cannot be used to treat the damage caused by atherosclerosis ( 5 ).…”

“…atherosclerosis is characterized by atherosclerotic plaques that result from inflammatory cell infiltration, lipid peroxidation, extracellular matrix deposition and other factors (1). Moreover, atherosclerosis remains a major cause of long-term morbidity and mortality worldwide as it is a prerequisite to a large number of cardiovascular diseases (cVds) (2); for example, the prevalence of cVds was predicted to reach 43.9% in the united States in 2030 (3), and in 2015 alone, 17.7 million people died from cVd worldwide (4).While a coronary artery bypass graft is widely performed for the revascularization of occluded vessels, it cannot be used to treat the damage caused by atherosclerosis (5). endothelial cell dysfunction is considered the main cause of atherosclerosis (6).…”