title: Midterm follow-up of patients with perioperative myocardial infarction after coronary artery bypass surgery: clinical significance of different treatment strategies.
abstract: BACKGROUND
  The purpose of the study was to analyze the causes of postoperative myocardial infarction (PMI) and the impact of different treatment strategies on (1) postoperative outcome, (2) major adverse events (MACE), and (3) postoperative Canadian Cardiovascular Society (CCS) at 3-year follow-up.
  
  
  METHODS
  Between May 2001 and July 2006, 113 patients with PMI were categorized in three groups: (A) conservative therapy (50 patients); (B) percutaneous coronary intervention (PCI) (25 patients), and (C) re-CABG (38 patients).
  
  
  RESULTS
  Overall in-hospital mortality was 7.1% (n = 8), being 10.0% in group A (n = 5), 4.0% in group B (n = 1) and 5.3% (n = 2) in group C (p = n.s.), respectively. The cumulative survival rates at 3 years were 90% for group A, 92% for group B, and 89.5% for group C (p = n.s). The MACE rate at 3-year follow-up for all patients was 27.4% and was significantly higher in group A (34%) and group B (36%) compared with group C (13.2%) (p = 0.05). Mean CCS was significantly reduced at follow-up in the groups compared with the preoperative angina class. However, group B and C showed a significant improvement in CCS compared with group A (p = 0.044/p < 0.001). Further group C was superior to group B (p = 0.032).
  
  
  CONCLUSIONS
  At 3 years of follow-up, this study showed no survival benefits from any therapeutical procedure; however patients treated with re-CABG had better freedom from repeat revascularization procedures and from MACCE. In addition, the conservative and PCI group had a higher incidence of recurrence of angina.
authors.affiliation: Department of Cardiac Surgery, Heart Center Dresden, Dresden, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Alexiou
authors.forename: Manuel
authors.initials: M
authors.lastname: Wilbring
authors.forename: Christian
authors.initials: C
authors.lastname: Koch
authors.forename: Utz
authors.initials: U
authors.lastname: Kappert
authors.forename: Sems
authors.initials: S
authors.lastname: Tugtekin
authors.forename: Klaus
authors.initials: K
authors.lastname: Matschke
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D059035:Perioperative Period; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents