Perioperative myocardial ischemia in patients undergoing sternectomy shortly after coronary artery bypass grafting.
Coronary revascularization reduces cardiac complications associated with noncardiac surgery in patients with severe coronary disease. However, patients undergoing emergency noncardiac surgery soon after coronary bypass operations may still be vulnerable to ischemic myocardial events. We prospectively evaluated the incidence of myocardial ischemia in 82 consecutive patents scheduled for sternectomy in the first (Group 1; 35 patients) or second (Group 2; 47 patients) week after coronary artery bypass graft (CABG) surgery. The interval between CABG surgery and sternectomy in Groups 1 and 2 was 6 days (range, 4-7 days) and 11 days (range, 8-14 days), respectively. Electrocardiographic (ECG) changes consistent with myocardial ischemia were assessed with a two-channel Holter system for 48 h. There were no between-group differences in updated Acute Physiology and Chronic Health Evaluation score, use of beta-blockers, or perioperative hemodynamic changes. The incidence of ECG changes consistent with myocardial ischemia was fivefold more frequent in Group 1 (22.85% versus 4.25%; P < 0.05). Of the ischemic patients in Group 1, 25% experienced a perioperative acute myocardial infarction (one was fatal). There were no infarcts in Group 2. Thus, patients appear to be prone to coronary events during sternectomy performed early after CABG surgery. Although the incidence of ischemia did not differ from that previously reported after CABG surgery alone, further investigation is required to determine whether the findings obtained in this high-risk population are generalizable to patients undergoing noncardiac surgery soon after uneventful CABG surgery.


CONCLUSIONS
This study demonstrates an increased incidence of myocardial ischemia when sternectomy for mediastinitis is performed within one week of coronary artery bypass graft surgery, and this ischemia is associated with a 25% incidence of myocardial infarction.
Glantz
Lucio
L
*Department of Anesthesiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; †Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; ‡Department of Anesthesiology, Wolfson Medical Center, Holon, Israel; §Department of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and ∥Intensive Care Unit and Departments of ¶Cardiology, #Anesthesiology, and **Plastic Surgery, Kaplan Medical Center, Rehovot, Israel (affiliated with The Hebrew University School of Medicine, Jerusalem, Israel).
Ezri
Tiberiu
T
Cohen
Yitzhak
Y
Konichezky
Sergio
S
Caspi
Abraham
A
Geva
Daniel
D
Leviav
Amos
A
D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001794:Blood Pressure / Q000502:physiology; D001026:Coronary Artery Bypass; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008480:Mediastinitis / Q000150:complications; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D017202:Myocardial Ischemia / Q000209:etiology*; D011182:Postoperative Care; D013249:Sternum / Q000601:surgery*