Baumgarten Heike, Rolf A, Weferling Maren, Graessle Tanja, Fischer-Rasokat Ulrich, Keller T, Kim W K, Dörr Oliver, Nef Holger, Holubec Tomas, Fichtlscherer Stephan, Walther Thomas, Hamm Christian Wilhelm, Choi Yeong-Hoon, Arsalan Mani, Liebetrau Christoph
University Hospital Frankfurt, Department of Cardiac Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
J Invasive Cardiol. 2023 Apr;35(4):E161-E168. doi: 10.25270/jic/21.00376. Epub 2023 Feb 24.
Early graft failure (EGF) after coronary artery bypass grafting (CABG) occurs in up to 12% of grafts, but is often clinically unapparent. EGF may result in perioperative myocardial infarction with consequently increased mortality. The aim of the present study was to analyze the incidence of clinically apparent EGF in patients undergoing CABG and the influence on mortality.
We analyzed outcomes of consecutive patients undergoing CABG from January 2015 to December 2018 with respect to postoperative emergency coronary angiography (CAG) due to suspected EGF and 30-day mortality. Patients with CAG-documented EGF were matched to patients without EGF to examine predictors of mortality.
The analysis included 5638 patients undergoing CABG. Eighty-six patients (1.5%) underwent emergency CAG due to suspected EGF. Clinically apparent EGF was observed in 61 of these patients (70.9%), whereas 14 (16.3%) had a culprit lesion in a native coronary artery. The majority of patients (n = 45; 52.3%) were treated with percutaneous coronary intervention and 31 (36%) underwent re-do CABG. The remaining patients were treated conservatively. The 30-day mortality rate of suspected EGF patients undergoing CAG was 22.4% (n = 19), which was higher than the mortality rate of 2.8% overall (P<.001); this remained higher after matching the EGF patients with the control group (11 [20.4%] vs 2 [4.0%]; P=.02).
Emergency CAG after CABG is rare and is primarily carried out in patients with EGF. The 30-day mortality rate of these patients is high, and EGF is an independent predictor of mortality. Perioperative CAG with subsequent treatment is mandatory in these patients.
冠状动脉旁路移植术（CABG）后早期移植物功能衰竭（EGF）在高达12%的移植物中发生，但在临床上往往不明显。EGF可能导致围手术期心肌梗死，从而增加死亡率。本研究的目的是分析接受CABG患者中临床明显EGF的发生率及其对死亡率的影响。
我们分析了2015年1月至2018年12月连续接受CABG患者的结局，这些患者因疑似EGF接受术后紧急冠状动脉造影（CAG）及30天死亡率。将CAG记录有EGF的患者与无EGF的患者进行匹配，以检查死亡率的预测因素。
分析纳入5638例接受CABG的患者。86例（1.5%）因疑似EGF接受紧急CAG。其中61例（70.9%）观察到临床明显的EGF，而14例（16.3%）在自身冠状动脉中有罪犯病变。大多数患者（n = 45；52.3%）接受经皮冠状动脉介入治疗，31例（36%）接受再次CABG。其余患者接受保守治疗。接受CAG的疑似EGF患者的30天死亡率为22.4%（n = 19），高于总体死亡率2.8%（P <.001）；在将EGF患者与对照组匹配后，该死亡率仍然较高（11例[20.4%]对2例[4.0%]；P =.02）。
CABG后紧急CAG很少见，主要在EGF患者中进行。这些患者的30天死亡率很高，且EGF是死亡率的独立预测因素。这些患者必须进行围手术期CAG及后续治疗。
