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. 2018 Apr 27:19:37-40.
doi: 10.1016/j.ijcha.2018.04.004. eCollection 2018 Jun.

The sternal wire code; Solving the problem of missing coronary artery bypass graft records during cardiac catheterization

David S Wald  1   2 , Ben J Wald  3 , Angus Radford  1 , Alex Shipolini  1
Affiliations

The sternal wire code; Solving the problem of missing coronary artery bypass graft records during cardiac catheterization

David S Wald et al. Int J Cardiol Heart Vasc. .

Erratum in

Abstract

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.

Keywords: CABG; Coronary angiography; Sternal wire code.

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Figures

Fig. 1
Fig. 1
Sternal wire code – how it works.
Fig. 2
Fig. 2
Example of (i) X-ray using sternal wire code (3 grafts, 1 from subclavian artery and 2 from aorta) and (ii) X-ray where code was not used.
See this image and copyright information in PMC

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