02. tbl. 110. árg. 2024

Incidence and outcomes of perioperative myocardial infarction associated with coronary artery bypass surgery

Aðgerðartengt hjartadrep við kransæðahjá-veituaðgerðir á Íslandi: Tíðni og áhrif á horfur sjúklinga

Sunna Rún Heiðarsdóttir1

Leon Arnar Heitmann1

Erla Liu Ting Gunnarsdóttir2

Sunna Lu Xi Gunnarsdóttir2

Egill Gauti Þorsteinsson1

Árni Johnsen2

Anders Jeppsson2,3

Tómas Guðbjartsson1,2

1Faculty of Medicine, 2Departments of Cardiothoraic Surgery, Landpitali University Hospital and 3Sahlgrenska University Hospital in Stockholm.

Correspondence: Tómas Guðbjartsson, tomasgud@landspitali.is

Key words: perioperative myocardial infarction, myocardial revascularisation, CABG, complications, 30 day mortality, long-term survival, cardiac biomarkers.

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.


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