Outcomes of Early Coronary Angiography or Revascularization After Cardiac Surgery
| Autor: | Douglas R. Johnston, M.Z. Tong, Eric E. Roselli, Kevin Chen, Eugene H. Blackstone, Faisal G. Bakaeen, A. Marc Gillinov, Shehab AlAnsari, Samir R. Kapadia, Gösta B. Pettersson, Beni R Verma, Edward G. Soltesz, Per Wierup, Lars G. Svensson, Stephen G. Ellis, Conrad Simpfendorfer, Vikram Sharma |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Tachycardia Male medicine.medical_specialty medicine.medical_treatment Myocardial Ischemia 030204 cardiovascular system & hematology Revascularization Ventricular tachycardia Coronary Angiography 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Postoperative Complications Internal medicine medicine Humans cardiovascular diseases Cardiac Surgical Procedures Coronary Artery Bypass Aged Retrospective Studies Fibrillation Troponin T business.industry Percutaneous coronary intervention Coronary ischemia Middle Aged medicine.disease Cardiac surgery Early Diagnosis Treatment Outcome 030228 respiratory system Cardiology Surgery Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 111(5) |
| ISSN: | 1552-6259 |
| Popis: | Background Early coronary ischemic events are uncommon after cardiac surgery, with little known about their management or associated outcomes. We evaluated clinical outcomes of patients undergoing coronary angiography ± percutaneous coronary intervention or redo coronary artery bypass grafting for suspected coronary ischemia within 3 weeks after index cardiac surgery. Methods This is a retrospective observational study based on data from 53,287 patients who underwent cardiac surgery at our institution (1996-2017); 180 patients (0.34%) satisfied the inclusion criteria. The primary outcome was 1-year all-cause mortality. Statistical evaluation involved χ2, analysis of variance, Kaplan-Meier, and receiver operating characteristic curve analyses. Results Most coronary angiography ± percutaneous coronary intervention and redo coronary artery bypass grafting procedures occurred in the first 2 weeks after index cardiac surgery. Patients presenting with ST elevation myocardial infarction (STEMI)/non-STEMI had the lowest 1-year mortality (13.5%), followed by patients with ventricular tachycardia/fibrillation (28.1%), and patients with non–ventricular tachycardia/fibrillation arrest or hemodynamic instability alone the worst (38.6%) (χ2 = 17.3, P = .001). Peak troponin T level after cardiac surgery was strongly predictive of 1-year mortality (area under the curve, 0.74; 95% confidence interval, 0.65-0.84; P Conclusions Although suspected myocardial ischemia requiring coronary angiography or intervention early after cardiac surgery was rare, mortality was high, particularly in presentations other than STEMI/non-STEMI. In patients with overt signs and symptoms of myocardial ischemia after index cardiac surgery, troponin T was not a reliable marker of underlying coronary or graft obstruction but was a robust predictor of 1-year mortality. |
| Databáze: | OpenAIRE |
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