Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case-control study.

IF 1.4 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
Lars Niclauss, Liam-Kani Roulet, Piergiorgio Tozzi, Filip Dulguerov, Ziyad Gunga, Anna Nowacka, Matthias Kirsch
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引用次数: 0

Abstract

Objective: The definition of coronary artery bypass graft (CABG)-associated myocardial infarction (MI) is controversial because the postoperative increases in cardiac enzyme activities are multifactorial in origin.

Methods: We performed a retrospective case-control study of patients who experienced perioperative MI (cardiac enzyme release, electrocardiographic changes, dysfunction on echocardiography) and those without ischemia to identify risk factors and enzyme activity thresholds.

Results: The estimated incidence of CABG-associated MI was 2.8%. The risk factors were a family history of cardiovascular disease (odds ratio (OR) 2.8), tobacco abuse (OR 3.8), recent MI (OR 3.6), and triple-vessel disease (OR 2.8). The MI group showed higher mortality (OR 2.3), prolonged intubation (OR 3.1), and a prolonged stay in intensive care (OR 4.3). The type 5 MI threshold (10 times the upper limit of the reference range (URL)) was exceeded in 88.4% (troponin I) and 96% (high-sensitivity troponin T; hs-cTnT) of patients without ischemia.

Conclusions: The frequent exceeding of conventional MI-indicating thresholds in patients without ischemia indicates their low specificity. An enzyme activity increase alone is of limited diagnostic value for perioperative MI, which is associated with greater mortality. Finally, the use of a higher threshold for hs-cTnT (>45 × URL) may increase its specificity for graft failure.

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来源期刊
CiteScore
3.20
自引率
0.00%
发文量
555
审稿时长
1 months
期刊介绍: _Journal of International Medical Research_ is a leading international journal for rapid publication of original medical, pre-clinical and clinical research, reviews, preliminary and pilot studies on a page charge basis. As a service to authors, every article accepted by peer review will be given a full technical edit to make papers as accessible and readable to the international medical community as rapidly as possible. Once the technical edit queries have been answered to the satisfaction of the journal, the paper will be published and made available freely to everyone under a creative commons licence. Symposium proceedings, summaries of presentations or collections of medical, pre-clinical or clinical data on a specific topic are welcome for publication as supplements. Print ISSN: 0300-0605
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