PMID- 32946843 OWN - NLM STAT- MEDLINE DCOM- 20210527 LR - 20210527 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 111 IP - 5 DP - 2021 May TI - Outcomes of Early Coronary Angiography or Revascularization After Cardiac Surgery. PG - 1494-1501 LID - S0003-4975(20)31475-2 [pii] LID - 10.1016/j.athoracsur.2020.06.113 [doi] AB - 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 chi(2), 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%) (chi(2) = 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 < .001) but did not predict the presence of coronary compromise. For acute graft failure, 1-year mortality was better with percutaneous coronary intervention (18.2%) than redo coronary artery bypass grafting (23.5%) or no indicated/feasible intervention (29.2%). 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. CI - Copyright (c) 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Sharma, Vikram AU - Sharma V AD - Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio. FAU - Chen, Kevin AU - Chen K AD - Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio. FAU - Alansari, Shehab A R AU - Alansari SAR AD - Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio. FAU - Verma, Beni AU - Verma B AD - Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio. FAU - Soltesz, Edward G AU - Soltesz EG AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Johnston, Douglas R AU - Johnston DR AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Tong, Michael Zhen-Yu AU - Tong MZ AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Roselli, Eric E AU - Roselli EE AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Wierup, Per AU - Wierup P AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Pettersson, Gosta B AU - Pettersson GB AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Gillinov, A Marc AU - Gillinov AM AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Ellis, Stephen G AU - Ellis SG AD - Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. FAU - Simpfendorfer, Conrad AU - Simpfendorfer C AD - Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. FAU - Blackstone, Eugene H AU - Blackstone EH AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. FAU - Kapadia, Samir AU - Kapadia S AD - Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. FAU - Svensson, Lars G AU - Svensson LG AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. FAU - Bakaeen, Faisal G AU - Bakaeen FG AD - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: bakaeef@ccf.org. LA - eng PT - Journal Article PT - Observational Study DEP - 20200916 PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - IM MH - Aged MH - *Cardiac Surgical Procedures MH - *Coronary Angiography MH - Coronary Artery Bypass MH - *Early Diagnosis MH - Female MH - Humans MH - Male MH - Middle Aged MH - Myocardial Ischemia/*diagnostic imaging/surgery MH - Percutaneous Coronary Intervention MH - Postoperative Complications/*diagnostic imaging/surgery MH - Retrospective Studies MH - Treatment Outcome EDAT- 2020/09/19 06:00 MHDA- 2021/05/28 06:00 CRDT- 2020/09/18 20:12 PHST- 2020/01/26 00:00 [received] PHST- 2020/05/20 00:00 [revised] PHST- 2020/06/08 00:00 [accepted] PHST- 2020/09/19 06:00 [pubmed] PHST- 2021/05/28 06:00 [medline] PHST- 2020/09/18 20:12 [entrez] AID - S0003-4975(20)31475-2 [pii] AID - 10.1016/j.athoracsur.2020.06.113 [doi] PST - ppublish SO - Ann Thorac Surg. 2021 May;111(5):1494-1501. doi: 10.1016/j.athoracsur.2020.06.113. Epub 2020 Sep 16.