076-IACUTE CORONARY ANGIOGRAPHY FOR MYOCARDIAL ISCHAEMIA AFTER CORONARY ARTERY BYPASS GRAFTING

Objectives: Coronary angiography is the gold standard to distinguish between graft-related and graft-unrelated myocardial ischaemia after coronary artery bypass grafting (CABG). The aim of this study was to describe our experience with acute coronary angiography after CABG. Methods: A total of 4446 patients (mean age 68 ± 9 years, 22% women) who underwent CABG surgery from 2007 to 2012 were included in a retrospective observational study. The prevalence of acute angiography after CABG was calculated and indications, findings and measures registered. Outcome variables were compared between patients who underwent angiography and those who did not. Results: Eighty-seven patients (2.0%) underwent acute coronary angiography. Patients undergoing angiography had ECG changes (92%), UCG alterations (48%), haemodynamic instability (28%), angina (15%) or arrhythmia (13%). Positive findings (occlusion, stenosis, graft kinking or spasm) were detected in 69% of the cases, 87% of these had one or more affected grafts. A combination of ECG modifications and haemodynamic instability had the strongest association with a positive finding (88%), while ECG modifications alone where associated with a positive finding in only 62%. A new revascularisation procedure was performed after angiography in 45% of the cases, either with percutaneous coronary intervention (PCI) (36%) or CABG (64%). Thirty-day mortality (6.9% vs 2.0%, P = 0.002) was significantly higher among angiography patients. Conclusion: Positive findings are revealed in about 70% of the acute coronary angiographies after CABG. Only ECG changes as indication for angiography have a weak association with positive findings. Postoperative myocardial ischaemia leading to acute coronary angiography is associated with increased mortality.