Management of ST Elevation After CABG

Initial Evaluation

The European Society of Cardiology recommends that patients with ST elevation after CABG should be urgently evaluated with transthoracic echocardiography to rule out mechanical complications and determine appropriate treatment based on the underlying cause 1
Immediate Doppler echocardiography is indicated to assess ventricular and valvular functions, loading conditions, and to detect mechanical complications 1
Invasive blood pressure monitoring with an arterial line is recommended for hemodynamic assessment 1

If graft failure is suspected and the patient has hemodynamic instability or cardiogenic shock, emergency coronary angiography with potential for PCI is indicated, as recommended by the European Heart Journal 1, 3
For patients with cardiogenic shock after CABG, the American Heart Association recommends intra-aortic balloon pump counterpulsation, especially if due to mechanical complications 1, 6
Complete revascularization should be considered during the index procedure, as recommended by the European Heart Journal 1

Aspirin should not be withheld before or after urgent CABG, as recommended by the American Heart Association 3, 7, 6
Aspirin (75-325 mg daily) should be prescribed as soon as possible (within 24 hours) after CABG unless contraindicated, as recommended by the American Heart Association 7

The American College of Cardiology recommends that CABG mortality is elevated for the first 3-7 days after infarction, and timing of repeat CABG is critical 8, 7

Routine intra-aortic balloon pumping is not indicated in all cases of ST elevation after CABG, as recommended by the European Heart Journal 1
The American Heart Association recommends avoiding glucocorticoids and nonsteroidal anti-inflammatory drugs for treatment of post-CABG pericarditis as they are potentially harmful 6