The sternal wire code; solving the problem of missing coronary artery bypass graft records during cardiac catheterization
IJC Heart and Vasculature
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Background: The sternal wire code records details of coronary artery bypass surgery (CABG) inside patients, based on the orientation of wires used for sternal closure. Visible on x-ray, the code overcomes the problem of missing graft-notes needed before repeat angiography. We determined (i) the potential value (ii) acceptability and (iii) accuracy of the code in practice. Methods: (i) Consecutive coronary angiogram reports (2015-2016 Barts, London) were reviewed to identify patients with previous CABG and those with and without graft-notes before angiography. (ii) UK surgeons were surveyed on whether they would insert the code during CABG. (iii) A clinician, blinded to operative details, interpreted 16 post-CABG x-rays, 8 with the code and 8 without. Results: (i) Of 6483 angiography patients, 559 had previous CABG (9.2%(8.5-10%). Graft-notes were missing in 91/559 (15.1%(12-18%)); almost all (88/91) among patients with acute myocardial infarction. (ii) In the survey, 66/71surgeons (93%(84-98%)) were willing to use the code. (iii) In the accuracy test, all coded x-rays were identified and 28/28 grafts correctly interpreted (p<0.001). Conclusions: About 1 in 6 patients with previous CABG, who require emergency coronary angiography, undergo this procedure without graft-notes and would benefit from the sternal wire code which appears clinically acceptable and accurate.