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Minimal Invasive Surgical Procedure of Inducing Myocardial Infarction in Mice
Published on: May 4, 2015
Myocardial infarction: an important factor for surgical decision making?
B R Osswald1, U Tochtermann, S Keller
1Department of Thoracic and Cardiovascular Surgery, University of Essen, Essen, Germany. brigitte.osswald@uk-essen.de
Insights
Recent myocardial infarction is a known risk factor. However, this study found that after appropriate statistical analysis, the impact of prior myocardial infarction on survival after coronary artery bypass grafting (CABG) diminishes over time.
Area of Science:
- Cardiovascular Surgery
- Clinical Outcomes Research
- Cardiac Risk Stratification
Background:
- Myocardial infarction (MI) is a recognized risk factor and predictor in cardiovascular risk scores.
- The clinical significance of recent MI in predicting outcomes after isolated coronary artery bypass grafting (CABG) requires re-evaluation.
Purpose of the Study:
- To assess the long-term impact of prior myocardial infarction (MI) on survival following isolated coronary artery bypass grafting (CABG).
- To determine if recent MI continues to be a significant predictor of adverse outcomes after CABG, justifying restrictive indications.
Main Methods:
- Retrospective analysis of 10,272 patients undergoing isolated CABG with a 10-year follow-up.
- Stratified Kaplan-Meier survival analysis and propensity score matching were employed.
- Patients were categorized based on the timing and type of prior myocardial infarction.
Main Results:
- Univariate analysis showed significantly worse survival in patients with a history of MI (P < 0.0001).
- Mortality risk was higher for more recent MIs in univariate analysis.
- Propensity score matching and analysis of long-term outcomes revealed no statistically significant difference between patients with or without prior MI.
Conclusions:
- While MI represents a risk factor in univariate analysis, its statistical relevance diminishes over time after CABG.
- The impact of recent MI on survival after CABG is not statistically significant when appropriate statistical methods are applied.
- Current risk scores may need re-evaluation regarding the predictive value of recent MI for isolated CABG.
Background:
Recent myocardial infarction has been identified as a risk factor and is currently used as a strong predictor in different scores. The aim of our study was to determine whether the impact of myocardial infarction, especially acute myocardial infarction, is still strong enough to justify a restrictive indication for isolated CABG procedure in patients with significant coronary artery disease.
Methods:
10 272 patients underwent isolated CABG at a single institution. A 10-year follow-up was performed with a completeness of 97.2 %.
Results:
6 107 (59.5 %) of the patients had a history of myocardial infarction. A stratified Kaplan-Meier analysis demonstrates a significantly worse survival for patients with myocardial infarction (chi-square value: 36.7, P < 0.0001). At a further differentiation for no myocardial infarction (n = 4 165), myocardial infarction > 90 days (n = 4 578), myocardial infarction up to 90 days (recent myocardial infarction) (n = 1 266) and ongoing acute myocardial infarction up to 15 days (n = 263), indicated a higher mortality for the more recent infarction in the univariate analysis. However, if patients with acute myocardial infarction in the past 6 years were analyzed separately, their risk remained at the same level as patients with non-acute myocardial infarction over the total observation period. Furthermore, propensity score matching revealed no statistical significant difference in the outcome of the patients.
Conclusions:
Structural myocardial damage represents a risk factor for survival after isolated CABG in univariate analysis. More appropriate statistical methods indicate a time-dependent loss of statistically relevant differences between patients with or without myocardial infarction prior to CABG. This is also true for "recent" myocardial infarction which is still part of current scores.
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