{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:14:48Z","timestamp":1780337688419,"version":"3.54.1"},"reference-count":28,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Peri-procedural myocardial infarction (PMI) after cardiac surgery is a significant yet often under-recognised complication, sometimes necessitating urgent coronary angiography (PMI-rCA). This meta-analysis evaluates its prevalence, angiographic findings, management strategies, and associated mortality. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Data from nine studies comprising 104,445 post-cardiac surgery patients were analysed. Among them, those undergoing PMI-rCA were categorised by treatment strategy: conservative management, percutaneous coronary intervention (PCI), or reperform surgery. A network meta-analysis compared mortality risks across these groups, with findings visualised using forest plots, network diagrams, and SUCRA rankings. Results: PMI-rCA was performed in 1205 patients (2%). Of these, 34.3% had no significant angiographic abnormalities, 53.7% exhibited graft failure, and 10.4% had native vessel ischemia. Management strategies included conservative treatment (55.5%), PCI (23.5%), and reperforming surgery (21%). Network meta-analysis indicated that conservative management was associated with the lowest mortality risk, followed by PCI, while reperforming surgery had the highest risk. Discussion: These findings highlight the complexity of PMI diagnosis and treatment. The high proportion of patients without significant angiographic abnormalities raises concerns about potential overuse of invasive procedures. Meanwhile, PCI appears to be a more favourable interventional strategy than reperforming surgery in terms of mortality outcomes. Conclusions: PMI requiring coronary angiography is uncommon but clinically significant, with a 16% mortality rate. A tailored, risk-based approach is essential to optimise management, balancing conservative therapy, PCI, and reperforming surgery based on individual patient profiles.<\/jats:p>","DOI":"10.3390\/jcm14103407","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T09:26:48Z","timestamp":1747128408000},"page":"3407","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Meta-Analytic Review of Coronary Angiography in Peri-Procedural Myocardial Injury and Infarction After Cardiac Surgery"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7325-4229","authenticated-orcid":false,"given":"Alberto Francesco","family":"Cereda","sequence":"first","affiliation":[{"name":"Cardiology Unit, ASST Santi Paolo e Carlo, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4055-5062","authenticated-orcid":false,"given":"Marco","family":"Toselli","sequence":"additional","affiliation":[{"name":"Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Cimaglia","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Gabriele","family":"Franchina","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Santi Paolo e Carlo, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Tua","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Santi Paolo e Carlo, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Carl\u00e0","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Santi Paolo e Carlo, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3121-8400","authenticated-orcid":false,"given":"Gabriele","family":"Tumminello","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6811-9305","authenticated-orcid":false,"given":"Paolo","family":"Aseni","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5862-1967","authenticated-orcid":false,"given":"Giuseppe Massimo","family":"Sangiorgi","sequence":"additional","affiliation":[{"name":"Cardiac Cath Lab, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0852-8040","authenticated-orcid":false,"given":"Marco","family":"Biolcati","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Santi Paolo e Carlo, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Spangaro","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Santi Paolo e Carlo, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8844-4042","authenticated-orcid":false,"given":"Matteo","family":"Rocchetti","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Santi Paolo e Carlo, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Pezzoli","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Santi Paolo e Carlo, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Vanelli","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4403-6182","authenticated-orcid":false,"given":"Stefano","family":"Lucreziotti","sequence":"additional","affiliation":[{"name":"Cardiology Unit, ASST Santi Paolo e Carlo, 20153 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1161\/CIR.0000000000001154","article-title":"Considerations on the Management of Acute Postoperative Ischemia After Cardiac Surgery: A Scientific Statement from the American Heart Association","volume":"148","author":"Gaudino","year":"2023","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1093\/icvts\/ivt558","article-title":"Optimal cut-off value for cardiac troponin I in ruling out Type 5 myocardial infarction","volume":"18","author":"Nybo","year":"2014","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4170","DOI":"10.1093\/eurheartj\/ehae416","article-title":"Great debate: Myocardial infarction after cardiac surgery must be redefined","volume":"45","author":"Gaudino","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"ezad415","DOI":"10.1093\/ejcts\/ezad415","article-title":"European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery","volume":"65","author":"Gaudino","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1186\/s13019-022-02027-x","article-title":"Prognostic value of high-sensitivity cardiac troponin I early after coronary artery bypass graft surgery","volume":"17","author":"Nanni","year":"2022","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1053\/euhj.2002.3171","article-title":"Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting","volume":"23","author":"Steuer","year":"2002","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S1010-7940(97)00268-6","article-title":"Significance and management of early graft failure after coronary artery bypass grafting: Feasibility and results of acute angiography and re-re-vascularization","volume":"12","author":"Rasmussen","year":"1997","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1093\/eurheartj\/ehac604","article-title":"Cardiac troponin release following coronary artery bypass grafting: Mechanisms and clinical implications","volume":"44","author":"Heuts","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ejcts.2006.03.062","article-title":"Emergency re-revascularization with percutaneous coronary intervention, reoperation, or conservative treatment in patients with acute perioperative graft failure following coronary artery bypass surgery","volume":"30","author":"Thielmann","year":"2006","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1093\/icvts\/ivr127","article-title":"Management of early postoperative coronary artery bypass graft failure","volume":"14","author":"Laflamme","year":"2012","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S226","DOI":"10.1161\/CIRCULATIONAHA.112.000347","article-title":"Impact of expeditious management of perioperative myocardial ischemia in patients undergoing isolated coronary artery bypass surgery","volume":"128","author":"Davierwala","year":"2013","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1016\/j.athoracsur.2014.12.063","article-title":"Results of emergency postoperative re-angiography after cardiac surgery procedures","volume":"99","author":"Gaudino","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"123","DOI":"10.3109\/14017431.2016.1143112","article-title":"Acute coronary angiography after coronary artery bypass grafting","volume":"50","author":"Hultgren","year":"2016","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s13019-019-0876-0","article-title":"Impact of coronary angiography early after CABG for suspected postoperative myocardial ischemia","volume":"14","author":"Rupprecht","year":"2019","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1177\/2047487319859972","article-title":"Outcomes of emergency coronary angiography after cardiac surgery","volume":"27","author":"Litwinowicz","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1016\/j.athoracsur.2020.06.113","article-title":"Outcomes of Early Coronary Angiography or Revascularization After Cardiac Surgery","volume":"111","author":"Sharma","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1002\/ccd.31337","article-title":"Urgent Coronary Angiography Following Cardiac Surgery: Insights from a High-Volume Cardiac Surgery Center","volume":"105","author":"Toselli","year":"2025","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jclinepi.2023.02.016","article-title":"A multifaceted graphical display, including treatment ranking, was developed to aid interpretation of network meta-analysis","volume":"157","author":"Nevill","year":"2023","journal-title":"J. Clin. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/ehjacc\/zuae014","article-title":"Periprocedural myocardial infarction and injury","volume":"13","author":"Spagnolo","year":"2024","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2407","DOI":"10.1093\/eurheartj\/ehac054","article-title":"Impact of myocardial injury after coronary artery bypass grafting on long-term prognosis","volume":"43","author":"Thielmann","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.jacc.2020.08.009","article-title":"SYNTAXExtended Survival Investigators Impact of Peri-Procedural Myocardial Infarction on Outcomes After Revascularization","volume":"76","author":"Hara","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S283","DOI":"10.21037\/jtd.2017.03.111","article-title":"CT angio for the evaluation of graft patency","volume":"9","author":"Crusco","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s12055-020-01029-5","article-title":"The impact of advances in percutaneous catheter interventions on redo cardiac surgery","volume":"37","author":"Trivedi","year":"2021","journal-title":"Indian. J. Thorac. Cardiovasc. Surg."},{"key":"ref_24","first-page":"209","article-title":"Periprocedural Myocardial Infarction in Contemporary Practice","volume":"8","author":"Lee","year":"2019","journal-title":"Interv. Cardiol. Clin."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1002\/clc.20819","article-title":"Periprocedural myocardial infarction: Review and classification","volume":"33","author":"Hanna","year":"2010","journal-title":"Clin. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.carrev.2020.03.027","article-title":"Acute Circumflex Occlusion After a Successful Mitral Valve Repair","volume":"21","author":"Felekos","year":"2020","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.jjcc.2021.08.030","article-title":"Clinical implications of troponin-T elevations following TAVR: Troponin Increase Following TAVR","volume":"79","author":"Imamura","year":"2022","journal-title":"J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1111\/jocs.14367","article-title":"The postoperative use of Impella as a ventricular assist device in high-risk patients undergoing coronary artery bypass surgery: A case series and comparison","volume":"35","author":"Sabra","year":"2020","journal-title":"J. Card. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3407\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:31:57Z","timestamp":1760031117000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,13]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14103407"],"URL":"https:\/\/doi.org\/10.3390\/jcm14103407","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,13]]}}}