Pulmonary Hypertension in Congenital Heart Disease: A Scientific Statement From the American Heart Association



symptoms of graft failure after cabg :: Article Creator

Silent Occlusion Increases Rehospitalization, Revascularization Risk After CABG

Angina-related rehospitalization and revascularization rates are higher among patients who receive coronary artery bypass grafting (CABG) and have in-hospital silent graft occlusion. These findings were published in Open Heart.

Although graft occlusions after CABG occur among up to 17% of patients, their effects on outcomes remain poorly understood.

The Diagnostic and Prognostic Value of Cardiac Biomarkers for Early Coronary Bypass Occlusion in Patients Undergoing Coronary Revascularization (CABGTrop; ClinicalTrials.Gov Identifier: NCT04595630) trial is an ongoing, single-center, prospective study conducted in Switzerland. Patients (N=292) who received CABG between 2021 and 2023 and had in-hospital silent graft occlusion were contacted by telephone at 12 months and asked whether they had an angina-related rehospitalization or coronary revascularization. Early silent graft occlusion was defined as occlusion detected by predischarge coronary computed tomography (cCT) without clinical signs of perioperative myocardial infarction (PMI).

The patients with (n=25) and without (n=267) silent occlusion had mean ages of 65±9.5 and 68±9.5 years, 80% and 86% were men, they had a BMI of 27±3.7 and 27±3.8, 24% and 15% received a previous percutaneous coronary intervention, and 64% and 55% had a previous myocardial infarction, respectively.

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…early silent graft occlusion after CABG was linked to a significantly higher incidence of angina-related rehospitalization and reintervention…

Intraoperative characteristics were similar between patients with and without silent occlusion, except that patients with occlusion had longer CABG surgery durations than those without occlusion (mean, 256 vs 230 min, respectively; P =.022).

After the procedure, the patients with silent occlusion, vs patients without, had a longer hospital stay (median, 10 vs 8.0 days; P <.001), a longer stay in the intensive care unit (median, 2.0 vs 1.0 days; P =.031), higher maximum cardiac troponin T (median, 586 vs 279 ng/L; P <.001), and higher maximum Creatine Kinase-MB (median, 45 vs 14 u/L; P =.006).

At an average follow-up of 14.5 months, the pooled rate of angina-related rehospitalizations was 6.2%, coronary reintervention was 4.8%. Myocardial infarction was 1%, stroke was 0.34%, and all-cause mortality was 3.1%.

Patients with silent occlusion, compared with patients without occlusion, were more likely to have angina-related rehospitalizations (28% vs 4.1%; P <.01) and coronary reinterventions (28% vs 2.6%; P <.01).

Mortality risk did not depend on occlusion status (P =.92).

At 18 months, the probability of freedom from angina-related rehospitalization was 63.3% with occlusion and 95.1% without occlusion (P <.001) and freedom from reintervention was 63.3% and 96.7% (P <.001), respectively.

Graft occlusion was associated with risk for rehospitalization (hazard ratio [HR], 8.55; 95% CI, 3.23-22.64; P <.001) and reintervention (HR, 15.12; 95% CI, 4.89-46.74; P <.001).

In a sensitivity analysis that used a propensity matching strategy, silent occlusion only tended to be related with rehospitalization risk (HR, 2.55; P =.18).

The major limitation of this study was the single-center, retrospective design, which may limit the generalizability of these findings.

The study authors concluded, "…early silent graft occlusion after CABG was linked to a significantly higher incidence of angina-related rehospitalization and reintervention, while its effect on MACCE [major adverse cardiovascular and cerebrovascular events] and mid-term prognosis remains uncertain…Extended follow-up and comparative analyses are necessary to determine the impact of proactive management, including ischemia testing, on long-term prognosis and survival in CABG patients."





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