Background
Methods
Search Strategy
Treatment Definition and Inclusion/Exclusion Criteria
PICO | Description |
---|---|
Population | Patients who developed perioperative myocardial ischemia immediately after coronary artery bypass grafting |
Intervention | Coronary angiography and repeat myocardial revascularization |
Comparison | None |
Outcomes | In-hospital/30-day mortality |
Data Extraction
Outcomes
Statistical Analysis
Results
Overall data
Author | Year | Country | Type of study | Study period | NHLBI quality rating | No. of control angiography | Negative findings at angiography (%) | Graft failure at angiography (%) | Repeat revascularization (%) | Repeat CABG (%) | PCI (%) | Early mortality (%) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Rasmussen | 1997 | Denmark | P | 1990-1995 | Fair | 59 | 27.1 | 72.9 | 45.8 | 45.8 | 0.0 | 5.1 |
Fabricius | 2001 | Germany | R | 1999 | Fair | 108 | 41.7 | 58.3 | 39.8 | 31.5 | 8.3 | 9.3 |
Thielmann | 2006 | Germany | P | 1999-2006 | Fair | 118 | 43.2 | 56.8 | 33.9 | 12.7 | 21.2 | 8.5 |
Karhunen | 2010 | Finland | R | 2000-2007 | Fair | 23 | 47.8 | 52.2 | 43.5 | 21.7 | 21.7 | 8.7 |
Laflamme | 2012 | Canada | R | 2003-2009 | Fair | 39 | 17.9 | 82.1 | 48.7 | 10.3 | 38.5 | 7.7 |
Szavits-Nossan | 2012 | Croatia | R | 1999-2009 | Fair | 55 | 21.8 | 65.5 | 69.1 | 14.5 | 54.5 | 23.6 |
Davierwala | 2013 | Germany | P | 2004-2010 | Fair | 399 | 36.1 | 61.2 | 41.1 | 32.6 | 8.5 | 7.3 |
Hultgren | 2016 | Sweden | R | 2007-2012 | Fair | 87 | 31.0 | 59.8 | 44.8 | 28.7 | 16.1 | 11.5 |
Preußer | 2017 | Germany | R | 2006-2013 | Fair | 168 | 23.2 | 52.4 | 53.6 | 17.9 | 35.7 | 10.7 |
Authors | Year of publication | Definition criteria |
---|---|---|
Rasmussen | 1997 | One or more of the following criteria: |
- new changes in the ST-segment in the ECG; | ||
- new Q-waves in the ECG; | ||
- CK-MB >80 U/L; | ||
- recurrent episodes of, or sustained ventricular tachyarrhythmia; | ||
- ventricular fibrillation; | ||
- hemodynamic deterioration and left ventricular failure. | ||
Fabricius | 2001 | One or more of the following criteria: |
- increase in CK/CK-MB above 10%; | ||
- ischemic electrocardiographic episodes (new changes in ST-segment lasting at least 1 min and involving a shift from baseline of greater than or equal to 0.1 mV of ST-depression and a new postoperative Q; | ||
- recurrent episodes of, or sustained ventricular tachyarrhythmia or ventricular fibrillation; | ||
- hemodynamic deterioration despite adequate inotropic support. | ||
Thielmann | 2006 | One or more of the following criteria: |
- cTnI serum level >20 ng/ml within 24 h after surgery; | ||
- ST-segment deviations at the J point in two or more contiguous leads with cut-off points ≥0.2 mV in leads V1, V2, or V3 and 0.1 mV in other leads or T-wave abnormalities in two or more contiguous leads as previously described; | ||
- hemodynamic instability despite intravenous inotropic support (>0.3 mg/kg/min). | ||
Karhunen | 2010 | One or more of the following criteria: |
- ST-level changes in ECG and increased levels of cardiac biomarkers, creatine phosphokinase isoenzyme CK-MB or Tn; | ||
- ECG changes or findings of poor myocardial function or a new wall motion abnormality in echocardiography. | ||
Laflamme | 2012 | One or more of the following criteria: |
- ECG modifications (new ST segment alterations or new Q wave); | ||
- refractory malignant arrhythmias; | ||
- elevation of cardiac biomarkers; | ||
- persistent low cardiac output syndrome; | ||
- new echocardiography wall motion abnormalities. | ||
Szavits-Nossan | 2012 | One or more of the following criteria: |
- hemodynamical deterioration; | ||
- new ST segment depression or elevation greater than 1 mm; | ||
- isoenzyme ratio of creatinine phosphokinase > 0.1; | ||
- cardiac troponin >0.1 mmol/L; | ||
- sustained ventricular tachycardia; | ||
- repeated nonsustained ventricular tachycardia and ventricular fibrillation. | ||
Davierwala | 2013 | One or more of the following criteria: |
- electrocardiographic alterations; | ||
- CK-MB >2x normal; | ||
- new regional wall motion abnormalities on echocardiography; | ||
- repetitive ventricular arrhythmias; | ||
- hemodynamic instability. | ||
Hultgren | 2016 | One or more of the following criteria: |
- ECG changes; | ||
- chest pain; | ||
- Aspartate aminotransferase (ASAT) on postoperative day 1 >2.5 μkat/l; | ||
- Troponin T measured 3-4 days after surgery > 2000 ng/L. | ||
Preußer | 2017 | One or more of the following criteria: |
- progressive postoperative elevation of cardiac enzymes; | ||
- ECG changes suggestive of myocardial ischemia (such as ST segment alteration); | ||
- major ventricular arrhythmia of unclear cause. |