Survival, adverse events and management of silent in-hospital coronary bypass graft occlusion.

Objectives: To assess mid-term outcomes in patients with early silent coronary bypass occlusion.

Methods: 292 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) between July 2021 and December 2023 were included in this prospective cohort study. Silent CABG occlusion was defined as a bypass occlusion detected by coronary CT before discharge and without clinical suspicion of perioperative myocardial infarction. The primary endpoint was the incidence of angina-related rehospitalisation and coronary revascularisation during the follow-up. The secondary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events, defined as a composite of all-cause mortality, myocardial infarction and stroke.

Results: The mean age was 67±9.5 years, with 85.3% (n=249) being male. Early silent occlusion was identified in 25 patients (8.5%). The median hospital stay was longer in the occlusion group with 10 days (IQR 8.0-12.0), versus 8.0 days (IQR 7.0-9.0) in the non-occlusion group (p<0.001). The median follow-up duration was 14.5 (IQR 13.3-16.5) months. The incidence of angina-related rehospitalisation and revascularisation was significantly higher in patients with graft occlusion (p<0.01). Cox proportional hazards regression identified graft occlusion as a strong predictor of rehospitalisation (HR=8.55, 95% CI: 3.23 to 22.64; p<0.001) and reintervention (HR=15.12, 95% CI: 4.89 to 46.74; p<0.001), indicating nearly a 9-fold higher risk of rehospitalisation and a 15-fold increased hazard of reintervention.

Conclusion: In-hospital silent graft occlusion following CABG is associated with a higher incidence of angina-related rehospitalisation and revascularisation during mid-term follow-up.

Trial registration number: NCT04595630.