Determinants and Prognosis of Myocardial Damage After Coronary Artery Bypass Grafting

Onorati, Francesco; Feo, Marisa De; Mastroroberto, Pasquale; Cristodoro, Lucia; Pezzo, Francesco; Renzulli, Attilio; Cotrufo, Maurizio

doi:10.1016/j.athoracsur.2004.07.060

Cited by 92 publications

(68 citation statements)

References 22 publications

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“…As the occurrence of MI is associated with mortality and other adverse outcomes such as inotropic requirement 5 and longer ventilation time, 19 treatments proven to improve survival after CABG, including aspirin, 22 statins, 23 and beta-blockers 24 should be administered. A lower threshold for angiography and return to theatre, in patients requiring inotropes or with prolonged ventilation should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…19 In addition to MI, predictors of 30-day or medium term mortality were female sex, NYHA class IV dyspnoea, and reduced renal function, all of which are incorporated in the EuroScore 20 and the Society of Thoracic Surgeons score. 11 We also found, as reported by others, 21 that revascularization with the left internal mammary artery was significantly associated with lower mortality.…”

Section: Independent Predictors Of MI and Mortalitymentioning

confidence: 99%

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Diagnosis of MI after CABG with high-sensitivity troponin T and new ECG or echocardiogram changes: relationship with mortality and validation of the Universal Definition of MI

Wang

Stewart

Ramanathan

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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Aims: Criteria for diagnosing myocardial infarction (MI) after coronary artery bypass grafting (CABG) are controversial. Uncertainties remain around the optimal threshold for biomarker elevation and the need for associated criteria. There are no studies of high-sensitivity troponin (hs-TnT) after CABG. We assessed whether using hs-TnT to define MI after CABG was associated with 30-day and medium-term mortality and evaluated the utility of adding to the troponin criteria new Q-waves or imaging evidence of new wall motion abnormality as suggested in the Universal Definition of MI. Methods: Isolated CABG was performed in 818 patients from July 2010 to June 2012 and hs-TnT was measured 12-24 hours after CABG. Patients with rising baseline or missing troponins (n=258) were excluded. Thresholds of 140 ng/l (10-times 99th percentile upper reference limit) and 500 ng/l (10-times coefficient of variation of 10% for fourthgeneration troponin T applied to hs-TnT) were prespecified. Results: Mean follow up was 1.8±0.6 years. On multivariate analyses, isolated hs-TnT rise >140 ng/l (n=360) or >500 ng/l (n=162) were not associated with mortality. Additional ECG and/or echocardiographic criteria plus hs-TnT >140 ng/l was associated with 30-day mortality (hazard ratio, HR, 4.92, 95% CI 1.34-18.1; p=0.017) and medium-term mortality (HR 3.44, p=0.030), whereas ECG and/or echocardiographic abnormalities with hs-TnT >500 ng/l was not (p=0.281 and p=0.123 for 30-day and medium-term mortality, respectively). Conclusions: A definition for MI following CABG using hs-TnT with a cut point of 10-times 99th percentile upper reference limit and ECG and/or echocardiographic criteria predicts 30-day and medium-term mortality. These findings validate the Third Universal Definition of type 5 MI.

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Section: Discussionmentioning

confidence: 99%

Section: Independent Predictors Of MI and Mortalitymentioning

confidence: 99%

Diagnosis of MI after CABG with high-sensitivity troponin T and new ECG or echocardiogram changes: relationship with mortality and validation of the Universal Definition of MI

Wang

Stewart

Ramanathan

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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“…21 Thus, the mechanism of cTn elevation in this context is likely multifactorial, which is supported by results of our and other data. 22,23 It is interesting and notable that in a multivariable model, new postoperative Q waves or LBBB was not associated with cTnT values; this may represent confounding by association with other factors that remained in the model such as use of intraaortic balloon counterpulsation or preoperative MI.…”

Section: Mohammed Et Al Troponin T After Cardiac Surgery 847mentioning

confidence: 99%

Prospective, Comprehensive Assessment of Cardiac Troponin T Testing After Coronary Artery Bypass Graft Surgery

et al. 2009

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Background-The significance and clinical role of cardiac troponin testing after coronary artery bypass grafting remain unclear. Methods and Results-Cardiac troponin T (cTnT) was measured during the first 24 hours after coronary artery bypass graft surgery in 847 consecutive patients. Only 17 patients (2.0%) had new Q waves or left bundle-branch block after surgery; however, cTnT elevation was observed in nearly all subjects, with a median cTnT concentration of 1.08 ng/mL overall.

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“…Perioperative myocardial infarction was defined as new Q waves Ͼ40 ms or a reduction in R waves Ͼ25% in at least 2 contiguous leads, new akinetic-dyskinetic segments at echocardiogram, and troponin I levels Ͼ3.1 g/L at 12 hours. 13 …”

Section: End Pointsmentioning

confidence: 99%

Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery

et al. 2006

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Background-Atrial fibrillation (AF) after cardiac surgery is associated with increased risk of complications, length of stay, and cost of care. Observational evidence suggests that patients who have undergone previous statin therapy have a lower incidence of postoperative AF. We tested this observation in a randomized, controlled trial. Methods and Results-Two hundred patients undergoing elective cardiac surgery with cardiopulmonary bypass, without previous statin treatment or history of AF, were enrolled. Patients were randomized to atorvastatin (40 mg/d, nϭ101) or placebo (nϭ99) starting 7 days before operation. The primary end point was incidence of postoperative AF; secondary end points were length of stay, 30-day major adverse cardiac and cerebrovascular events, and postoperative C-reactive protein (CRP) variations. Atorvastatin significantly reduced the incidence of AF versus placebo (35% versus 57%, Pϭ0.003). Accordingly, length of stay was longer in the placebo versus atorvastatin arm (6.9Ϯ1.4 versus 6.3Ϯ1.2 days, Pϭ0.001). Peak CRP levels were lower in patients without AF (Pϭ0.01), irrespective of randomization assignment. Multivariable analysis showed that atorvastatin treatment conferred a 61% reduction in risk of AF (odds ratio 0.39, 95% confidence interval 0.18 to 0.85, Pϭ0.017), whereas high postoperative CRP levels were associated with increased risk (odds ratio 2.0, 95% confidence interval 1.2 to 7.0, Pϭ0.01). The incidence of major adverse cardiac and cerebrovascular events at 30 days was similar in the 2 arms. Conclusions-Treatment with atorvastatin 40 mg/d, initiated 7 days before surgery, significantly reduces the incidence of postoperative AF after elective cardiac surgery with cardiopulmonary bypass and shortens hospital stay. These results may influence practice patterns with regard to adjuvant pharmacological therapy before cardiac surgery.

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Determinants and Prognosis of Myocardial Damage After Coronary Artery Bypass Grafting

Cited by 92 publications

References 22 publications

Diagnosis of MI after CABG with high-sensitivity troponin T and new ECG or echocardiogram changes: relationship with mortality and validation of the Universal Definition of MI

Diagnosis of MI after CABG with high-sensitivity troponin T and new ECG or echocardiogram changes: relationship with mortality and validation of the Universal Definition of MI

Prospective, Comprehensive Assessment of Cardiac Troponin T Testing After Coronary Artery Bypass Graft Surgery

Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery

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