P6079Urgent percutaneous intervention versus conservative management in patients presenting with post-operative myocardial ischemia after coronary artery bypass graft surgery

Abstract

Background: Postoperative myocardial ischemia (PMI) is a major complication of coronary artery bypass graft (CABG) surgery with relevant prognostic implications. Purpose: The aim of the study was to review the angiographic findings of patients who underwent urgent coronary angiography for suspected acute PMI at our institution. In particular we sought to assess the diagnostic findings and procedural and mid-term clinical outcome of bailout percutaneous coronary interventions (PCI) after early graft failure. Methods: Between January 2009 and December 2016 40 patients underwent urgent coronary angiography for suspected PMI within 72 hours from CABG surgery. The angiographic, procedural and clinical outcome were collected and examined retrospectively. Results: Early graft failure was detected in 26 out of 40 (65%) patients and 31 out of 73 (42.5%) examined grafts. In cases where early graft failure was not detected, coronary angiography revealed incomplete surgical revascularization (5 out of 14 patients, 36%), diffuse spasm that reverted with high intracoronary doses of nitrates (3/14 patients, 21%), or patent grafts without any detectable culprit lesion (6/14, 43%). PCI was performed in 21 out of 40 (52.5%) patients who underwent urgent coronary angiography, 1 patient (2.5%) was candidate to redo-CABG, and 18 (45%) patients were treated conservatively. PCI patients presented higher eventfree survival rate compared with patients treated conservatively (log-rank=4.2, p=0.04). Hemodynamic instability at presentation, conservative treatment and PCI failure were associated with poor outcome, but only the PCI failure remained a significant prognostic determinant at multivariate analysis (HR=21.5; CI: 1.58- 291; p=0.02). Conclusion: Bailout PCI after early CABG failure provides better MACCE-Free survival rate at 1-year compared with conservative treatment. Nevertheless, bailout PCI remains a high-risk procedure and the PCI failure is associated with poor mid-term clinical outcome.