Postoperative MI occurs in 2-15% of patients following cardiac surgery. It leads to reduced survival, both short and long term, longer hospital stays, and results in a greater burden on hospital finances. Establishing a definite diagnosis of postoperative MI is not an easy task. Current recommendations suggest that biomarker values above ten times the 99th percentile of the normal reference range during the initial 72 hrs following CABG, when associated with the appearance of new pathological Q-waves or new LBBB, or angiographically documented new graft or native coronary artery occlusion, or imaging evidence of new loss of viable myocardium, should be considered as diagnostic of CABG-related myocardial infarction. In general, Type 5 MI is mainly due to an ischemic event because of either new graft native artery occlusion or inadequate cardio protection. Specific treatment of myocardial ischemia after CABG depends primarily on findings obtained by imaging techniques, namely, coronary angiography. In symptomatic patients, early graft occlusion has been identified as the cause of ischemia in 75% of cases. There are around 8% occlusions of venous grafts following CABG in the perioperative phase of angiography. Emergency PCI with stenting is a viable option apart from emergency surgical reintervention and is associated with good results and fewer complications. It is advised that the PCI should be done for native vessels(if possible), as targeting the freshly occluded venous grafts or the anastomosis can lead to the risk of embolization or perforation. Surgery should only be done if the graft or native artery appears non-amenable for PCI, or if several grafts are occluded.

Our case is of a middle-aged male, a known case of hypertension, diabetes, triple vessel disease, who underwent CABG. On post op Day 2, he developed STEMI, CAG done revealed Subtotal occlusion in the mid part of the LIMA graft with thrombus. As a native, LAD was a CTO, so revascularization with PTCA/Stenting of LIMA was planned. Successful PTCA and stenting to LIMA to the LAD was done using two drug-eluting stents.

TBA...