What is the best treatment for patient with ongoing myocardial ischemia after coronary artery bypass surgery?

摘要

Perioperative graft failure following coronary artery bypass grafting (CABG) may result in acutemyocardial ischemia. Whether acute percutaneous coronary intervention, emergency reoperation or conservativeintensive care treatment should be used is currently unknown. Between 2003 and 2009, 39 of the 5598 patientswho underwent isolated CABG surgery underwent early postoperative coronary angiography for suspectedmyocardial ischemia. Following angiography, two groups were identified: patients who underwent immediatelyreintervention (group 1); and those treated conservatively (group 2). Primary study endpoints were mortality andpostoperative myocardial infarct size. Postoperative coronary angiography revealed early perioperative bypassgraft failure in 32 of 39 patients. Acute percutaneous coronary intervention was performed in 15 patients, redo-CABG in 4 patients and conservative treatment in 13 patients. The number of failing bypass grafts weresignificantly higher in group 1 compared with group 2 (P = 0.03). A trend toward lower post-procedural peakcardiac troponin T and creatinine phosphokinase serum levels in group 1 was observed (163.0 vs. 206.0 and 4.35vs. 5.53, respectively) (P = 0.06 and 0.16). Early reintervention may limit the extent of myocardial cellulardamage compared with conservative medical strategy in patients with myocardial ischemia due to early graftfailure.