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Current incidence and determinants of perioperative myocardial infarction in coronary artery surgery
S C Greaves1, J D Rutherford, S F Aranki
1Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Insights
Emergency surgery, longer aortic cross-clamp times, recent heart attack, and prior bypass surgery increase perioperative myocardial infarction (PMI) risk after coronary artery bypass grafting (CABG).
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Research
Background:
- Patients undergoing coronary artery bypass grafting (CABG) are increasingly older, have undergone prior CABG, and exhibit reduced left ventricular function.
- This demographic shift necessitates a re-evaluation of perioperative myocardial infarction (PMI) risk factors.
Purpose of the Study:
- To identify and evaluate the determinants of perioperative myocardial infarction (PMI) in patients undergoing isolated coronary artery bypass grafting (CABG).
Main Methods:
- A retrospective review of 499 consecutive patients undergoing isolated CABG.
- Multivariate logistic regression analysis was employed to identify independent risk factors for PMI.
Main Results:
- The incidence of definite PMI was 5.0% and probable PMI was 2.0%.
- Independent risk factors for PMI included emergency surgery (OR 3.1), aortic cross-clamp time > 100 minutes (OR 4.2), myocardial infarction within the preceding week (OR 2.6), and previous revascularization (OR 2.4).
Conclusions:
- Both preoperative and intraoperative factors significantly influence the risk of PMI following CABG.
- Despite evolving patient profiles, PMI incidence remains comparable to earlier series, likely due to surgical and postoperative care advancements.
Abstract:
Increasingly, patients undergoing coronary artery bypass grafting (CABG) are elders, have had previous CABG, and have poor left ventricular function. To evaluate determinants of perioperative myocardial infarction (PMI) after isolated CABG, 499 consecutive patients were reviewed. Definite PMI (total peak creatine kinase [CK] > 700 U/L, creatine kinase MB [CK-MB] > 30 ng/ml, and new pathologic electrocardiographic Q waves) occurred in 25 patients (5.0%) and probable PMI (total peak CK > 700 U/L, CK-MB > 30 ng/ml, and a new wall-motion abnormality) occurred in 10 (2.0%) patients. According to multivariate logistic regression analysis, independent risk factors for definite or probable PMI (adds ratios; 95% confidence intervals) were emergency surgery (3.1; 1.1 to 8.4; p = 0.003), aortic cross-clamp time > 100 minutes (4.2; 1.6 to 11.2; p = 0.004), myocardial infarction in the preceding week (2.6; 1.0 to 6.4; p = 0.04), and previous revascularization (2.4; 1.1 to 5.2; p = 0.02). In conclusion, both preoperative and intraoperative factors influence the risk of PMI after CABG. Despite changes in the profile of patients undergoing CABG, the incidence of PMI in this tertiary center is comparable with that found in earlier series, probably because of improvements in surgical techniques and postoperative care.