Current incidence and determinants of perioperative myocardial infarction in coronary artery surgery.
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.
Greaves
S C
SC
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Rutherford
J D
JD
Aranki
S F
SF
Cohn
L H
LH
Couper
G S
GS
Adams
D H
DH
Rizzo
R J
RJ
Collins
J J
JJ
Antman
E M
EM
D000368:Aged; D002315:Cardiopulmonary Bypass; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006801:Humans; D015994:Incidence; D007527:Isoenzymes; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000201:enzymology / Q000209:etiology* / Q000503:physiopathology; D016017:Odds Ratio; D011182:Postoperative Care; D011183:Postoperative Complications; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications
D007527:Isoenzymes; D003402:Creatine Kinase