title: Results of emergency postoperative re-angiography after cardiac surgery procedures.
abstract: BACKGROUND
  The purpose of this study was to evaluate the diagnostic and therapeutic role of emergency coronary angiography (ECA) in the setting of acute ischemic or hemodynamic instability after cardiac surgery.
  
  
  METHODS
  Between January 2005 and September 2014 we prospectively collected data from a consecutive cohort of 5,275 patients who underwent cardiac surgery. Patients who underwent ECA due to new ST-segment changes on electrocardiogram (ECG), ventricular arrhythmias, cardiac arrest or hemodynamic collapse, new changes in regional wall motion, or any other relevant suspect of myocardial ischemia during postoperative intensive care unit stay were included.
  
  
  RESULTS
  Forty patients (0.7% of the overall population) were enrolled. Nineteen patients (47.5%) received isolated coronary surgery, 21 (52.5%) underwent valve or aortic or combined operations. The most common indications to ECA were new ECG or echo signs of acute ischemia (62.5%). The mean time from primary operation to ECA was 51 hours (27 minutes to 9 days). Graft failure was found in 17 cases (42.5%), native coronary artery occlusion in 7 (20%), and coronary spasm in 5 (12.5%). No pathologic alterations were found in 7 cases (17.5%). Three patients (7.5%) underwent reoperation (group 1), 15 (37.5%) underwent percutaneous interventions (PCI) (group 2), and 22 (55%) were managed conservatively (group 3). In-hospital mortality was 100% in group 1, 6% in group 2, and 0% in group 3; 93% of the patients who underwent PCI had complete resolution of the ischemic or hemodynamic problems. No complications related to angiography occurred. Kaplan-Meier survival curves differed significantly according to the post-angiography management. At multivariate analysis combined surgery and the strategy of treatment were independent predictors of long-term mortality.
  
  
  CONCLUSIONS
  Emergency coronary angiography is safe and allows diagnosis and resolution of the instability in the great majority of cases. An ECA should be the first-line measure in case of acute ischemic or hemodynamic instability after cardiac surgery.
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy. Electronic address: mgaudino@tiscali.it.
authors: Mario
authors: M
authors: Gaudino
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Marialisa
authors: M
authors: Nesta
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Francesco
authors: F
authors: Burzotta
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Carlo
authors: C
authors: Trani
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Valentina
authors: V
authors: Coluccia
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Filippo
authors: F
authors: Crea
authors: Department of Cardiovascular Sciences, Catholic University, Rome, Italy.
authors: Massimo
authors: M
authors: Massetti
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D017023:Coronary Angiography; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000401:mortality; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome