Acute ischemic syndromes following coronary artery bypass graft surgery.
Coronary artery bypass graft (CABG) surgery, performed for the control of angina pectoris, leads to postoperative relief from symptoms in most patients. Amelioration of ischemia and improvement in exercise capacity after CABG are well documented. However, patients currently undergoing CABG are more complex than in the past--they are older and are maintained on medical therapy for longer periods. A large number of these patients have had one or more previous myocardial revascularization procedures. The post-operative period would appear to be a time of vulnerability for coronary events. However, previous investigators have focused on the pre- and intraoperative aspects of peri-CABG ischemia. Outcome data suggest that the postoperative interval is at least equally important as a determinant of short- and long-term morbidity and mortality. We discuss the epidemiology, etiology, pathophysiology, and treatment of ischemic syndromes in the postoperative period after CABG. In addition, we review recent data from a series of 14 patients, observed at our institution, who underwent cardiac catheterization and, in some cases, angioplasty of the culprit vessel in the immediate postoperative period.
Hirsch
W S
WS
Division of Cardiovascular Disease, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA.
Ledley
G S
GS
Kotler
M N
MN
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D015906:Angioplasty, Balloon, Coronary; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000601:surgery; D003329:Coronary Vasospasm / Q000150:complications; D005260:Female; D006083:Graft Occlusion, Vascular / Q000150:complications; D006801:Humans; D008297:Male; D008323:Mammary Arteries; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012086:Reoperation; D012501:Saphenous Vein
D000319:Adrenergic beta-Antagonists; D000700:Analgesics; D002121:Calcium Channel Blockers; D010975:Platelet Aggregation Inhibitors