Outcomes of early coronary angiography or revascularization after cardiac surgery.

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 (CAG)±percutaneous coronary intervention (PCI) or redo-coronary artery bypass grafting (redo-CABG) for suspected coronary ischemia within 3 weeks of 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-square, ANOVA, Kaplan-Meier, and ROC analyses. RESULTS Most of the CAG+/-PCI and redo-CABG procedures occurred in the first 2 weeks after index cardiac surgery. Patients presenting with STEMI/NSTEMI had the lowest 1-year mortality (13.5%), followed by patients with ventricular tachycardia/fibrillation (VT/VF) (28.1%), and worst in patients with non-VT/VF arrest or hemodynamic instability alone (38.6%) (χ2 = 17.3, p=0.001). Peak troponin T (TnT) level after cardiac surgery was strongly predictive of 1-year mortality (AUC 0.74; CI 0.646-0.839, p<0 .001), but did not predict the presence of coronary compromise. For acute graft failure, 1-year mortality was better with PCI (18.2%) than redo-CABG (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/NSTEMI. In patients with overt signs/symptoms of myocardial ischemia following index cardiac surgery, TnT is not a reliable marker of underlying coronary or graft obstruction, but is a robust predictor of 1-year mortality.