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Perioperative myocardial infarction in cardiac surgery - risk factors and consequences: a case control study
Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
2000 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, Vol. 34, no 5, 522-527 p.Article in journal (Refereed) Published
Abstract [en]

Objective. The aim of the study was to analyze risk factors and clinical outcome in patients sustaining perioperative myocardial infarction (PMI) after cardiac surgery.

Design. A retrospective, case control study was conducted, in which 42 patients fulfilling both Q-wave criteria and enzyme criteria for PMI, or autopsy diagnosis, from a cohort of 1147 operated on during the same time period were compared with matched controls. A follow-up by telephone interview was conducted, on average 24 months after the operation.

Results. Unstable angina, peripheral vascular disease, short stature and low body weight were more prevalent in the PMI group. Intraoperative remarks of poor quality coronary vessels and incomplete revascularization were more frequent in the PMI group, 30-day mortality was 24% in the PMI group vs 0% in the control group (p < 0.01). The postoperative course was more complicated and protracted in the PMI group. At follow-up, the control group managed significantly better with regard to freedom from angina and the need for nitroglycerine. However, 24 of the 30 survivors in the PMI group reported an improved quality of life after surgery.

Conclusions. We found that PMI was mainly associated with coronary surgery and that unstable angina was the most important preoperative risk factor for PMI. Poorer conditions for revascularization may explain some of the infarcts and could also contribute to the impaired long-term outcome in the PMI group.

Place, publisher, year, edition, pages
2000. Vol. 34, no 5, 522-527 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26845DOI: 10.1080/140174300750064710Local ID: 11463OAI: oai:DiVA.org:liu-26845DiVA: diva2:247395
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-06Bibliographically approved
In thesis
1. Perioperative myocardial infarction in cardiac surgery: a diagnostic dilemma
Open this publication in new window or tab >>Perioperative myocardial infarction in cardiac surgery: a diagnostic dilemma
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Perioperative myocardial infarction remains a major cause of morbidity and mortality after cardiac surgery. In spite of this there is no consensus regarding diagnostic criteria and consequently the reported incidence varies widely. In this thesis risk factors for PMI and outcome after PMI were studied in a retrospective case control study on 42 patients fulfilling strict criteria for PM! collected from a cohort of 1147 adult cardiac surgical patients. Traditional diagnostic criteria for PMI, release characteristics of biochemical markers for myocardial injury and VCG were evaluated in a prospective study on 302 consecutive patients undergoing isolated frrst time CABG. PM! was found to be a problem mainly associated with surgery for ischaemic heart disease. Unstable angina and unfavourable conditions for revascularisation were found to be the most important risk factors for PMI. Patients with PM! had an impaired short-term and mid-term outcome compared with controls. In the prospective study a sustained elevation of troponin-T was used as a marker for permanent myocardial damage. It was demonstrated that Q-wave criteria, previously accepted as the gold standard for diagnosis of PM!, correlated poorly with biochemical markers of myocardial injury and clinical outcome. One fourth of the patients with new Q-waves after CABG had no evidence of permanent myocardial injury. The use of biochemical markers for early diagnosis of myocardial injury is interfered by unspecific release unrelated to permanent myocardial damage. However, little is known about the magnitude of this "diagnostic noise". To address this issue a subgroup with no or minimal permanent myocardial damage was identified by use of the unique release characteristics of troponin-T. The time frame of unspecific release and the plasma levels of CKMB and troponin-T caused by unspecific release were assessed. A substantial early release of both CKMB and troponin-T nnrelated to permanent myocardial injury was found. As the unspecific release can be expected to differ depending on type of cardiac intervention this type of knowledge may prevent inappropriate comparisons. Repeated early sampling for CKMB provided additional information of value for early identification of patients who would later show sustained elevation of troponin-T. VCG was found to correlate better with sustained levels oftroponin-T and clinical outcome than scalar ECG. To conclude, diagnostic pitfalls associated with both ECG and enzymatic diagnosis of PM! were addressed and novel approaches to improve detection of permanent myocardial damage are suggested.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2001. 54 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 668
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27472 (URN)12125 (Local ID)91-7219-961-X (ISBN)12125 (Archive number)12125 (OAI)
Public defence
2001-04-20, Berzeliussalen, Universitetssjukhuset, Linköping, 13:15 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-06Bibliographically approved

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Dahlin, Lars-GöranSvedjeholm, Rolf

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