Occurrence of myocardial ischemia immediately after coronary revascularization using radial arterial conduits.
OBJECTIVE
To assess the incidence of myocardial ischemia in patients receiving radial arterial and left internal thoracic arterial conduits (RA+LITA) during the postrevascularization period.


METHODS
Nonrandomized observational sequential cohort.


METHODS
University hospital.


METHODS
Thirty adult patients, scheduled for elective coronary artery bypass graft surgery with RA+LITA, compared with 30 patients who received saphenous vein graft and left internal thoracic arterial conduits.


METHODS
None.


RESULTS
Myocardial ischemic episodes were defined as reversible ST-segment depressions or elevations >or=1 mm and >or=2 mm at J +60 msec and lasting >or=1 minute using 2-channel Holter monitoring. During the post-cardiopulmonary bypass period, a significantly higher number of patients with >or=2 mm ischemic episodes (21.7%; p = 0.015) and higher number of >or=2 mm ischemic episodes per hour (0.19 +/- 0.4 episodes/hr; p = 0.03) were observed in the radial artery group versus the comparison group (0% of patients and 0 episodes/hr). During the postoperative period (24 hours), a significantly longer duration of >or=2 mm ischemic episodes was observed in the radial artery group (24 +/- 33 minutes v 8.4 +/- 21 minutes; p = 0.046). Radial artery graft, preoperative calcium antagonists, and pulmonary arterial mean pressure were independent predictors of the duration and area under the ST-segment curve of >or=2 mm ischemic episodes during the postoperative period.


CONCLUSIONS
There is an association between the use of the radial artery graft and the incidence and severity of >or=2 mm postrevascularization ischemic episodes.
Apostolidou
I A
IA
Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Washington University School of Medicine, St. Louis, MO 63110, USA. apostoli@notes.wustl.edu
Skubas
N J
NJ
Despotis
G J
GJ
Kallinteri
E
E
Hogue
C W
CW
Lappas
D G
DG
Barner
H B
HB
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis; D017534:Radial Artery / Q000637:transplantation; D012501:Saphenous Vein / Q000637:transplantation