University of Oulu

Biancari, F., Anttila, V., Dell’Aquila, A., Airaksinen, J., Brascia, D. (2018) Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis. Journal of Cardiothoracic Surgery, 13 (1). doi:10.1186/s13019-018-0710-0

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

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Author: Biancari, Fausto1,2,3; Anttila, Vesa3; Dell’Aquila, Angelo M.4;
Organizations: 1Department of Surgery, University of Turku
2Department of Surgery, University of Oulu
3Heart Center, Turku University Hospital and University of Turku
4Department of Cardiac Surgery, University Hospital, Münster
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe201804136543
Language: English
Published: Springer Nature, 2018
Publish Date: 2018-04-13
Description:

Abstract

Background: Perioperative 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).

Methods: A literature review was performed through PubMed, Scopus, ScienceDirect and Google Scholar to identify studies published since 1990 evaluating the outcome of PMI after CABG.

Results: Nine 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%).

Conclusions: Control angiography seems to be a valid life-saving strategy to guide repeat revascularization in hemodynamically stable patients suffering PMI after CABG.

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Series: Journal of cardiothoracic surgery
ISSN: 1749-8090
ISSN-E: 1749-8090
ISSN-L: 1749-8090
Volume: 13
Issue: 1
Article number: 24
DOI: 10.1186/s13019-018-0710-0
OADOI: https://oadoi.org/10.1186/s13019-018-0710-0
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3121 Internal medicine
Subjects:
Copyright information: © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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