Perioperative myocardial infarction in patients undergoing surgery myocardial revascularization

Abstract

IntroductionPerioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized.ObjectiveTo identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft.MethodsRetrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used.ResultsWe analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases.ConclusionThe frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death.

Minimally invasive cardiac surgery: A systematic review and meta-analysis

“…Irrespective of these differences these studies consistently show a poorer outcome for those suffering perioperative MI whether this be in terms of having more cardiac events during 30 months of follow-up [22], poorer left ventricular function [23], or higher 30-day mortality [21]. In our meta-analysis the incidence of MI was not significantly different between the two groups.…”

“…Diagnostic criteria varies including for example enzyme release or electrocardiographic criteria [21]. Perhaps, as a consequence of this the incidence of MI also varies between 10.8% [21], 10.8% [22] and 24.1% [23].…”

There is one more thing to be done: ECMO!

“…Moreover, as our team works in general hospitals, the good results with the ECMO support changed the mind of the ICU groups and nowadays we are having neonates, infants and adults patients, going on ECMO for exclusively respiratory problems. In conclusion, we can mention our results to strengthen the concept that training is the right way to go because our ECMO weaning rate has increased from 60% to 88.9% and our late survival, after hospital discharge, from 10% to 77.8% in the pediatric group (cardiac and respiratory patients) [ 2 ] .…”

Analysis of Readmissions to The Intensive Care Unit After Coronary Artery Bypass Surgery: Ten Years’ Experience

“…Risk factors associated with atherosclerosis (smoking, hyperlipidemia, diabetes, and hypertension) and frequent comorbidities (such as COPD, neurovascular disease, chronic kidney disease) in CABG patients may contribute to the high mortality rate in ICU readmissions. Another potential cause is not only difficult to manage, but also a high risk of mortality from cardiac complications such as postoperative myocardial infarction in CABG patients [ 25 ] . In our patient group, mortality was observed in 11 of the 34 patients who were taken to the ICU due to cardiac reasons, and these readmissions were the first in terms of causes of mortality.…”