Unplanned postoperative catheterization during admission for coronary artery bypass grafting is neither cheap nor benign, but may rescue patients

Anthony V Norman; Andrew M Young; Raymond J Strobel; Mark Joseph; Leora Yarboro; Nicholas R Teman; Mohammed Quader; Irving L Kron

doi:10.1016/j.jtcvs.2023.08.039

Unplanned postoperative catheterization during admission for coronary artery bypass grafting is neither cheap nor benign, but may rescue patients

J Thorac Cardiovasc Surg. 2023 Sep 1:S0022-5223(23)00750-X. doi: 10.1016/j.jtcvs.2023.08.039. Online ahead of print.

Authors

Anthony V Norman¹, Andrew M Young¹, Raymond J Strobel¹, Mark Joseph², Leora Yarboro¹, Nicholas R Teman¹, Mohammed Quader³, Irving L Kron⁴

Affiliations

¹ Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Va.
² Department of Cardiothoracic Surgery, Carilion Clinic, Roanoke, Va.
³ Department of Cardiac Surgery, Virginia Commonwealth University, Richmond, Va.
⁴ Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Va. Electronic address: ilk@virginia.edu.

PMID: 37659463
PMCID: PMC10904671 (available on 2025-03-01)
DOI: 10.1016/j.jtcvs.2023.08.039

Abstract

Objective: Literature describing outcomes of myocardial ischemia after coronary artery bypass grafting is sparse. We hypothesized these patients had more complications and incurred higher costs of care.

Methods: Using adult cardiac surgery data and cardiac catheterization (CathPCI) data from the Virginia Cardiac Services Quality Initiative, we identified patients who underwent unplanned cardiac catheterization after coronary artery bypass grafting from 2018 to 2021. Adult cardiac surgery data were matched to CathPCI data examining earliest in-hospital catheterization. Patients not requiring catheterization served as the control group.

Results: We identified 10,597 patients who underwent isolated coronary artery bypass grafting, of whom 41 of 10,597 underwent unplanned cardiac catheterization. A total of 21 of 41 patients (51%) received percutaneous coronary intervention, most commonly for non-ST-elevation myocardial infarction (n = 7, 33%) and ST-elevation myocardial infarction (n = 6, 29%). Postoperative cardiac arrest occurred in 14 patients (40%). In patients who underwent percutaneous coronary intervention, 14 (67%) had a single lesion, 4 (19%) had 2 lesions, and 3 (14%) had 3 lesions. The left anterior descending artery (38%) was the most frequently intervened upon vessel. Patients who underwent catheterization were more likely to require balloon pump support (26% vs 11%), to have prolonged ventilation (57% vs 20%), to have renal failure (17% vs 7.1%), and to undergo reintubation (37% vs 3.8%, all P < .04). There was no statistical difference in operative mortality (4.9% vs 2.3%, P = .2) or failure to rescue (4.9% vs 1.6%, P = .14). Total costs were higher in patients who underwent unplanned catheterization ($81,293 vs $37,011, P < .001).

Conclusions: Unplanned catheterization after coronary artery bypass grafting is infrequent but associated with more complications and a higher cost of care. Therefore, determination of an association with operative mortality in patients with suspected ischemia after coronary artery bypass grafting requires additional study.

Keywords: cardiac catheterization; coronary artery bypass grafting; myocardial ischemia; percutaneous coronary intervention; perioperative care.

Grants and funding

T32 HL007849/HL/NHLBI NIH HHS/United States