Incidence and outcomes of perioperative myocardial infarction associated with coronary artery bypass surgery
INTRODUCTION: Perioperative myocardial infarction (PMI) after CABG can contribute to in-hospital morbidity and mortality, however, its clinical significance on long-term outcome, remains inadequately addressed. We studied both 30-day mortality and long-term effects of PMI in Icelandic CABG-patients.
MATERIALS AND METHODS: A retrospective nationwide-study on 1446 consecutive CABG-patients operated at Landspitali in Iceland 2002-2018 without evidence of preoperative myocardial infarction. PMI was defined as a tenfold elevetion in serum-CK-MB associated with new ECG changes or diagnostic imaging consistent with ischemia. Patients with PMI were compared to a reference group with uni- and multivariate analyses. Long-term and MACCE-free survival were estimated with the Kaplan-Meier method and logistic regression used to determine factors associated with PMI. The mean follow-up time was 8.3 years.
RESULTS: Out of 1446 patients 78 (5.4%) were diagnosed with PMI (range: 0-15.5%) with a significant annual decline in the incidence of PMI (12.7%, p<0.001). Over the same period preoperative aspirin use increased by 22.3% (p<0.018). PMI patients had a higher rate of short-term complications and a 11.5% 30-day mortality rate compared to 0.4% for non-PMI patients. PMI was found to be a predictor of 30-day mortality (OR 15.44, 95% CI: 6.89-34.67). PMI patients had worse 5-year MACCE-free survival (69.2% vs. 84.7, p=0,01), although overall survival was comparable between the groups.
CONCLUSIONS: Although PMI after CABG is associated with significantly higher rates of short-term complications and 30-day mortality, long-term survival was similar to the reference group. Therefore, the mortality risk attributable to PMI appears to diminish after the immediate postoperative period.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:110 |
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| Enthalten in: |
Laeknabladid - 110(2024), 2 vom: 01. Feb., Seite 85-92 |
| Sprache: |
Isländisch |
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| Beteiligte Personen: |
Heidarsdottir, Sunna Run [VerfasserIn] |
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| Links: |
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| Themen: |
30 day mortality |
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| Anmerkungen: |
Date Completed 26.01.2024 Date Revised 29.02.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.17992/lbl.2024.02.781 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Incidence and outcomes of perioperative myocardial infarction associated with coronary artery bypass surgery |
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| 520 | |a INTRODUCTION: Perioperative myocardial infarction (PMI) after CABG can contribute to in-hospital morbidity and mortality, however, its clinical significance on long-term outcome, remains inadequately addressed. We studied both 30-day mortality and long-term effects of PMI in Icelandic CABG-patients | ||
| 520 | |a MATERIALS AND METHODS: A retrospective nationwide-study on 1446 consecutive CABG-patients operated at Landspitali in Iceland 2002-2018 without evidence of preoperative myocardial infarction. PMI was defined as a tenfold elevetion in serum-CK-MB associated with new ECG changes or diagnostic imaging consistent with ischemia. Patients with PMI were compared to a reference group with uni- and multivariate analyses. Long-term and MACCE-free survival were estimated with the Kaplan-Meier method and logistic regression used to determine factors associated with PMI. The mean follow-up time was 8.3 years | ||
| 520 | |a RESULTS: Out of 1446 patients 78 (5.4%) were diagnosed with PMI (range: 0-15.5%) with a significant annual decline in the incidence of PMI (12.7%, p<0.001). Over the same period preoperative aspirin use increased by 22.3% (p<0.018). PMI patients had a higher rate of short-term complications and a 11.5% 30-day mortality rate compared to 0.4% for non-PMI patients. PMI was found to be a predictor of 30-day mortality (OR 15.44, 95% CI: 6.89-34.67). PMI patients had worse 5-year MACCE-free survival (69.2% vs. 84.7, p=0,01), although overall survival was comparable between the groups | ||
| 520 | |a CONCLUSIONS: Although PMI after CABG is associated with significantly higher rates of short-term complications and 30-day mortality, long-term survival was similar to the reference group. Therefore, the mortality risk attributable to PMI appears to diminish after the immediate postoperative period | ||
| 650 | 4 | |a English Abstract | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a 30 day mortality | |
| 650 | 4 | |a CABG | |
| 650 | 4 | |a cardiac biomarkers | |
| 650 | 4 | |a complications | |
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| 700 | 1 | |a Heitmann, Leon Arnar |e verfasserin |4 aut | |
| 700 | 1 | |a Gunnarsdottir, Erla Liu Ting |e verfasserin |4 aut | |
| 700 | 1 | |a Gunnarsdottir, Sunna Lu Xi |e verfasserin |4 aut | |
| 700 | 1 | |a Thorsteinsson, Egill Gauti |e verfasserin |4 aut | |
| 700 | 1 | |a Johnsen, Arni |e verfasserin |4 aut | |
| 700 | 1 | |a Jeppsson, Anders |e verfasserin |4 aut | |
| 700 | 1 | |a Gudbjartsson, Tomas |e verfasserin |4 aut | |
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