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

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 perio...

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Main Authors: Fausto Biancari, Vesa Anttila, Angelo M. Dell’Aquila, Juhani K. E. Airaksinen, Debora Brascia
Format: Article
Language:English
Published: BMC 2018-02-01
Series:Journal of Cardiothoracic Surgery
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13019-018-0710-0
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spelling doaj-71b9a4f6d3e84e4f9ac2b59fbaf40dc02020-11-24T23:56:41ZengBMCJournal of Cardiothoracic Surgery1749-80902018-02-011311710.1186/s13019-018-0710-0Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysisFausto Biancari0Vesa Anttila1Angelo M. Dell’Aquila2Juhani K. E. Airaksinen3Debora Brascia4Department of Surgery, University of TurkuHeart Center, Turku University Hospital and University of TurkuDepartment of Cardiac Surgery, University HospitalHeart Center, Turku University Hospital and University of TurkuDepartment of Surgery, University of TurkuAbstract 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.http://link.springer.com/article/10.1186/s13019-018-0710-0Coronary artery bypassPerioperative myocardial infarctionAngiographyPercutaneous coronary intervention
collection DOAJ
language English
format Article
sources DOAJ
author Fausto Biancari
Vesa Anttila
Angelo M. Dell’Aquila
Juhani K. E. Airaksinen
Debora Brascia
spellingShingle Fausto Biancari
Vesa Anttila
Angelo M. Dell’Aquila
Juhani K. E. Airaksinen
Debora Brascia
Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis
Journal of Cardiothoracic Surgery
Coronary artery bypass
Perioperative myocardial infarction
Angiography
Percutaneous coronary intervention
author_facet Fausto Biancari
Vesa Anttila
Angelo M. Dell’Aquila
Juhani K. E. Airaksinen
Debora Brascia
author_sort Fausto Biancari
title Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis
title_short Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis
title_full Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis
title_fullStr Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis
title_full_unstemmed Control angiography for perioperative myocardial Ischemia after coronary surgery: meta-analysis
title_sort control angiography for perioperative myocardial ischemia after coronary surgery: meta-analysis
publisher BMC
series Journal of Cardiothoracic Surgery
issn 1749-8090
publishDate 2018-02-01
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.
topic Coronary artery bypass
Perioperative myocardial infarction
Angiography
Percutaneous coronary intervention
url http://link.springer.com/article/10.1186/s13019-018-0710-0
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