Predictive factors for coronary angioplasty in early postoperative follow-up of heart surgery

Abstract

Postoperative myocardial ischemia involves 2 to 8% of the patients who have benefitted from cardiac surgery and is associated with a higher mortality. However, the choice of patients who should benefit for coronary angiography is complex. The aim of the study is to identify the factors driving the realization of coronarography during immediate postoperative time period and thus to analyze their relevance in predicting the existence of a coronary lesion. This unicentric retrospective study has analyzed all patients who have benefitted from diagnostic coronary angiography during postoperative cardiac surgery period from 2013 to 2020 at the University Hospital of Toulouse. Demographic, clinical, surgical and coronarography data were collected ( Table 1 ). 101 patients were analyzed, mean age was 61 years old and 75% were men. 65 showed coronary lesions on post operatory coronarography and 40 justified immediate angioplasty. Age was associated with occurrence of mortality (58,8 vs. 65,2 years old; P = 0,02), EUROSCORE II (3,28% vs. 2,45%; P = 0,02), postoperative hemodynamic support (69,4% vs. 21,5%; P < 0,01) and a new dialysis (41,7% vs. 13,9%; P = 0,002). Amongst the socio-demographic, preoperative, intraoperative and postoperative data, only tobacco use was an angioplasty risk factor (22,5 vs. 8,2%; P = 0,04). Amongst the grounds for coronary angiography, only ischemic ECG changes were associated with angioplasty action. We observed a significant relationship depending on the criteria number justifying coronarography and the realization of angioplasty: 21% if 1 criterion, 45% if 2 criteria, 50% if 3 criteria and 75% if 4 criteria ( Fig. 1 ). In our study, 40% of the patients benefitted from coronary angioplasty in the early postoperative period of cardiac surgery. Ischemic ECG modifications were meaningfully associated with revascularization. The existence of 4 criteria justifying coronarography led to angioplasty in 75% cases.