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Follow-up catheterization of patients with myocardial infarction during coronary artery bypass surgery
Insights
Intraoperative myocardial infarction is common after aortocoronary bypass surgery, affecting 19% of patients. These heart attacks are not always due to graft occlusion.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Aortocoronary bypass grafting is a common surgical procedure.
- Myocardial infarction (MI) is a potential complication following cardiac surgery.
Purpose of the Study:
- To determine the incidence of ECG-evidence of myocardial infarction during aortocoronary bypass surgery.
- To investigate the relationship between graft status and myocardial infarction post-surgery.
Main Methods:
- Retrospective analysis of 197 patients undergoing aortocoronary bypass grafting over 30 months.
- ECG monitoring for evidence of myocardial infarction.
- Postoperative coronary arteriography in a subset of patients with intraoperative infarction.
Main Results:
- 19% (38/197) of patients experienced ECG evidence of myocardial infarction.
- Infartions were more frequent with multiple grafts and typically occurred in grafted vessel territories, often the inferior wall.
- In 11 patients with intraoperative infarction, 7 had patent grafts, and 4 had occluded grafts; hypokinesis was observed in both groups.
Conclusions:
- Intraoperative myocardial infarction is a significant complication of aortocoronary bypass surgery.
- Graft occlusion is not the sole cause of intraoperative myocardial infarction.
Abstract:
Of 197 consecutive patients having aortocoronary bypass grafts over a 30 month period, 38 (19 per cent) had ECG evidence of myocardial infarction. The infarctions occurred more commonly in patients receiving multiple grafts. The infarctions were usually in areas supplied by grafted vessels. The infarctions occurred most often in the inferior wall, even when multiple vessels were grafted. Eleven patients with intraoperative infarction have had repeat postoperative coronary arteriograms. Seven had all grafts patent; three of these patients had hypokinesis of the infarcted wall. Four of the 11 patients had one or more occluded grafts; three of these patients had an area of hypokinesis. We conclude that intraoperative myocardial infarction is a common problem in aortocoronary bypass surgery and is not necessarily caused by graft occlusion.