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OBJECTIVE: Peri-operative MI is a relatively rare but
potentially fatal complication following CABG and is due to graft related problems in a significant proportion of cases. Angiography, gold standard for pre-operative angina remains extremely underutilised for evaluation of peri-operative ischaemia. The aim of this study was to evaluate the role ofangiography in the management of peri-operativeischaemia.
METHODS: Between January 2011 until Septmeber2012, we performed 2312 isolated primary coronary artery byp
ass grafts. 26(0.01%) of these patients needed peri-operative angiography. The patients for angiography were identified
based on our institutional algorithm. In presence of ST changes, recurrent VT/VF or increase in inotropic support, TnI
and CPK-MB levels were measured and TEE performed. In presence of above signs and new regional wall dysfunction, the patient was taken for angiography
RESULTS: ECGchanges were seen in 19(79.1%) cases. arrhythmias in 8(33.3%) and ST changes in 11(45.8%). Eight (33.3%) patients had haemodynamic compromise. CK/ CK-MB ratio appeared elevated above the threshold of 10% set as significant was found only in
4 (16.6%) patients. Troponin (TnI) was raised in 6 patients (25%). TEE revealed regional wall dysfunction in 6 out of 2
4 (25%) patients undergoing angiography.
Mean time between operation and ngiography was 24.58±6.71 hrs .Of the 6, patients undergoing angiography, 18 (69 %) had graft issues and needed re-operation. The overall mortality in the group re-operated for graft issues was 2 out of 18(11.1%). In the group where angiography was carried out within 48 hours no mortality was seen.
CONCLUSIONS: In conclusion, angiography remains an extremely useful tool in identifying graft related causes and to discriminate them from non graft related ischaemia thus allowing appropriate management and based on our findings we would recommend a more liberal and early application of this diagnostic modality in this setting.