Abstract
Objectives Coronary artery bypass grafting (CABG) is the “gold standard” for patients with multiple
vessel coronary artery disease (CAD). However, there is no “gold standard” to control
bypass patency immediately postoperatively. “Post-completion” control angiogram (CA)
is not routinely performed. We retrospectively analyzed the data of all patients undergoing
urgent coronary angiogram post-CABG at our center.
Methods Between January 2005 and June 2011, a total of 6,025 patients underwent CABG (isolated
or combined) for CAD in our hospital. In patients who underwent urgent postoperative
CA, high serum cardiac enzymes (>100 CK-MB), severe new ECG changes, or unexpected
low left ventricular function were present.
Results A total of 106 patients (1.8%) underwent post-CABG urgent coronary angiogram. Overall
30-day mortality in this cohort was 8.5%. The average time between the cardiac operation
and the coronary angiogram in these patients was 3.41 ± 5.68 days. The rates for an
urgent coronary angiogram were 1.3% (n = 25), 2% (n = 65), and 1.8% (n = 16) for total arterial, combined arterial, and venous and solely venous CABG, respectively.
Twenty-four percent of patients underwent CABG bypass revision, while 32% of the patients
underwent PTCA, stenting, or both. Younger patients, female patients, smaller patients,
and patients receiving a combined arterial and venous revascularization were at a
higher risk for an unplanned postoperative CA in the multivariate risk analysis.
Conclusion This study shows that the necessity for urgent post-CABG coronary angiogram is low
(1.8%). However, more than half of the patients undergoing postoperative coronary
angiogram needed reintervention, and, in spite of it, had high mortality. “Completion”
control angiogram is not always feasible, patients at higher risk (e.g., female patients)
should be identified and post-CABG coronary angiogram performed as soon as possible
without undue delay, or a primary hybrid approach with an intraoperative CA should
be applied.
Keywords
CABG - hybrid OR - coronary angiogram
