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Long-term survival following postoperative myocardial infraction after coronary artery bypass surgery
Radosław Litwinowicz1,2, Piotr Mazur1,3, Piotr Śliwiński2
1Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Insights
Postoperative myocardial infarction (MI) after coronary artery bypass grafting (CABG) significantly reduces survival. Incomplete revascularization, female gender, and non-elective surgery are key risk factors.
Area of Science:
- Cardiology
- Cardiac Surgery
- Outcomes Research
Background:
- Postoperative myocardial infarction (MI) is a significant complication following coronary artery bypass grafting (CABG).
- Limited data exists on the long-term outcomes of patients experiencing postoperative MI after CABG.
Purpose of the Study:
- To investigate the incidence, risk factors, and short- and long-term outcomes of postoperative MI in patients undergoing isolated CABG.
Main Methods:
- Retrospective analysis of 4,642 patients undergoing isolated CABG between January 2014 and December 2016.
- Identification of type 5 MI cases according to the Fourth Universal Definition of Myocardial Infarction.
- Follow-up assessment for mortality and complications over a mean of 5.1 years.
Main Results:
- 141 patients (3.04%) were diagnosed with postoperative MI.
- Postoperative MI was linked to higher rates of complications (e.g., cardiac tamponade) and increased short- and long-term mortality.
- Risk factors included incomplete revascularization (OR 2.25), non-elective surgery (OR 1.68), and female gender (OR 1.48).
Conclusions:
- Postoperative MI following CABG is associated with diminished short- and long-term survival.
- Incomplete revascularization, female gender, and non-elective surgery are primary risk factors for postoperative MI after CABG.
Background:
Postoperative myocardial infraction (MI) is a serious complication among patients undergoing Coronary Artery Bypass Grafting (CABG). Data on the impact of postoperative MI on patients undergoing CABG, specifically with respect to their long term outcomes are sparse.
Methods:
We retrospectively analyzed all patients who underwent isolated CABG between January 2014 and December 2016 and identified those who fulfilled the definition of the type 5MI following CABG according to the Fourth Universal Definition of Myocardial Infarction.
Results:
A total of 4,642 CABG patients were identified, of whom 141 (3.04%) were diagnosed with postoperative MI. The mean follow-up time was 5.1±2.07 years (range, 4.4-6.9 years). Postoperative MI was more common in patients with recent acute coronary syndrome, when compared to stable angina (22.8% vs. 31.9%; P=0.011) and in those with non-elective versus planned surgery (28.4% vs. 18.4%; P=0.003). Postoperative MI after CABG was associated with an increased rate of postoperative complications, including cardiac tamponade and re exploration for bleeding. Mortality after postoperative MI was higher at short-term follow-up (up to one year) and long-term follow-up (up to five years). The risk factors for postoperative MI after CABG were incomplete revascularization (IR) [OR (95% CI): 2.25 (1.59-3.12), P=0.001], non-elective surgery [OR (95% CI): 1.68 (1.10-2.54), P=0.015] and female gender [OR (95% CI): 1.48 (1.01-2.18), P=0.045].
Conclusions:
PMI after CABG is associated with reduced short- and long-term survival. The main risk factors for postoperative MI are IR, female gender, and non-elective surgery.
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