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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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 |
work_keys_str_mv |
AT faustobiancari controlangiographyforperioperativemyocardialischemiaaftercoronarysurgerymetaanalysis AT vesaanttila controlangiographyforperioperativemyocardialischemiaaftercoronarysurgerymetaanalysis AT angelomdellaquila controlangiographyforperioperativemyocardialischemiaaftercoronarysurgerymetaanalysis AT juhanikeairaksinen controlangiographyforperioperativemyocardialischemiaaftercoronarysurgerymetaanalysis AT deborabrascia controlangiographyforperioperativemyocardialischemiaaftercoronarysurgerymetaanalysis |
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