Risk factors for myocardial infarction during coronary artery bypass graft surgery

Abstract

Patients with a particular thrombotic profile may be at greater risk of myocardial infarction during coronary artery bypass graft surgery. The thrombotic profile of 50 patients admitted to hospital with stable angina pectoris was determined prior to haemodynamic investigation. ECG results and determination of cardiac enzymes showed that 12 patients had suffered a perioperative myocardial infarction. These patients had a higher mean atherosclerotic score (42.1 +/- 10.5 vs 32.9 +/- 13, P less than 0.02), a longer aortic cross clamp time (59 +/- 15.2 vs 45.7 +/- 16.3 min, P less than 0.05), lower serum levels of protein C (101.2 +/- 26 vs 124.7 +/- 31.4%, P less than 0.05) and tissue plasminogen activator (322 +/- 580 vs 2307 +/- 2830 IU ml-1, P less than 0.01). There were no differences between the two groups in Jenkin's coronary score, the number and type of grafts, ejection fraction, left ventricular end-diastolic pressure, lipid profile or levels of markers of platelet release. In addition to a more severe distal coronary atheroma and a longer aortic cross-clamp time, patients with impaired endothelial fibrinolytic activity appeared to be at greater risk of myocardial infarction during coronary artery bypass graft surgery.

Genetics of Coagulation: Considerations for Cardiac Surgery

“…68 Protein C deficiency in cardiac surgery is associated with intraoperative graft thrombosis in off-pump coronary artery bypass graft (CABG) surgery, a higher incidence of perioperative myocardial infarction, and postoperative embolic strokes. 69,70 The use of full aprotinin doses in patients with protein C deficiency undergoing repeat sternotomies with CPB has been safely done with the preemptive administration of 4 units of FFP to normalize protein C levels in one case, 71 which is similar to what has been reported with protein S deficiency. 72 Source: Modified with permission from Grocott HP, Clements F, Landolfo K. Coronary artery bypass graft surgery in a patient with hereditary protein S deficiency.…”

“…68 Protein C deficiency in cardiac surgery is associated with intraoperative graft thrombosis in off-pump coronary artery bypass graft (CABG) surgery, a higher incidence of perioperative myocardial infarction, and postoperative embolic strokes. 69,70 The use of full aprotinin doses in patients with protein C deficiency undergoing repeat sternotomies with CPB has been safely done with the preemptive administration of 4 units of FFP to normalize protein C levels in one case, 71 …”

Angiographic quantification of diffuse coronary artery disease: Reliability and prognostic value for bypass operations

“…Several previous studies attempting to quantify the angiographic extent of coronary disease to predict operative risk have concentrated on the amount of myocardium at risk or the severity of proximal coronary lesions. [2][3][4][5][6] Although the extent of disease in the distal coronary vessels is generally accepted to be associated with a poor surgical outcome, measures of distal coronary disease have not been included in predictive models 1,[7][8][9][10][11][12] because they were considered subjective and prone to interobserver bias. 1 To our knowledge, only 2 studies have attempted to include a measure of distal disease status in predictive models.…”

Intracardiac Thrombosis and Acute Right Ventricular Failure Following Complex Reoperative Cardiac Surgery With Aprotinin and Deep Hypothermic Circulatory Arrest

“…16 In the cardiac surgical population, protein C deficiency has been associated with intraoperative graft thromboses, an increased incidence of perioperative myocardial infarction, and embolic stroke. 17,18 Normalization of protein C and S levels with fresh-frozen plasma (FFP) has been reported before the safe conduct of a repeat (reoperative) sternotomy with full-dose aprotinin in a protein C-deficient patient, 19 as has an uneventful reoperative heart transplantation using half-dose aprotonin in a patient with protein S deficiency and prior coronary artery bypass graft (CABG) thromboses. 20 Normalization of factor levels appears to be the key to eliminating much of the hyperthrombotic risk of this entity in the setting of cardiac surgery.…”