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ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2009 August;50(4):535-43

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Prognosis of perioperative myocardial infarction after off-pump coronary artery bypass surgery

Vanden Eynden F. 1, Cartier R. 2, Marcheix B. 2, Demers P. 2, Bouchard D. 2

1 Department of Cardiac Surgery Erasmus Hospital, Free University of Brussels Brussels, Belgium 2 Department of Cardiovascular Surgery Montreal Heart Institute and “Université de Montréal” Montreal, Quebec, Canada


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Aim. Perioperative myocardial infarction (PMI) is associated with long-term morbidity and mortality. CKMB cut-off level and importance of Q-wave MI have not been specifically studied after off-pump coronary artery bypass (OPCAB) surgery. The aim of this paper was to study the impact of PMI (CKMB ≥20 times the upper normal limit [UNL] 100 mg/L) and CKMB rise (5-20 UNL) on survival and recurrent major adverse cardiac event (MACE) after OPCAB surgery.
Methods. One thousand consecutive prospectively followed OPCAB patients operated between September 1996 and March 2004 were analyzed. Follow-up was complete in 97% of the cohort. Average follow-up was 66±28 months.
Results. Overall and cardiac survival at 10 years was 70±2.6% and 88+2.3%, respectively. Evolving MI (EMI) occurred in 1.8%, postoperative non-Q MI (NQMI) in 1.3%, and Q-wave MI (QMI) in 2.0%. Operative mortality was higher in PMI patients (P<0.001). After adjusting for risk factors, survivors of EMI (HR: 2.0) and QMI (HR: 2.3) but not NQMI had a lower life expectancy and a higher long-term cardiac mortality (EMI: HR: 3.5; QMI: HR: 4.3) compare to non-PMI patients. EMI and QMI were associated with a decrease MACE-free survival. CKMB 5-10 UNL did not affect overall and cardiac mortality. CKMB 10-20 UNL was associated to lower cardiac survival.
Conclusion. PMI (CKMB>20 UNL) was a strong predictor of operative mortality. QMI and EMI were predictors of long-term mortality and cardiac morbidity after OPCAB surgery. CKMB 10-20 UNL affected long-term cardiac survival but not overall survival.

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