Is new ST-segment elevation after coronary artery bypass of clinical importance in the absence of perioperative myocardial infarction?

Loeb, Henry S.; Gunnar, William; Thomas, D. K.

doi:10.1016/j.jelectrocard.2006.08.098

Cited by 9 publications

(4 citation statements)

References 29 publications

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“…1 , 2 ST-segment changes may also develop due to pericardial inflammation and are usually benign if occur after 24 h of the procedure. 2 , 6 However, persistent, regional ST elevation within 24 h of the surgery is abnormal and shouldn’t be ignored as it may be suggestive of STEMI. One reason for this may be the early closure of grafts, reported to be as high as 3%.…”

Section: Discussionmentioning

confidence: 99%

Drug-eluting balloon to treat immediate post-coronary artery bypass grafting ST-elevation myocardial infarction: a case report

Shah,

Haider,

Poudyal

et al. 2024

European Heart Journal - Case Reports

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Background Coronary artery bypass graft (CABG) surgery represents a major cardiovascular operation and may be associated with post-operative ST-elevation myocardial infarction (STEMI) due to graft failure. This is challenging to diagnose and treat as the implanted grafts may be prone to complications when treated percutaneously with drug-eluting stents. Case Summary A man in his 60 s underwent CABG and developed new persistent ST elevations of 2 mm in anterior leads with no significant chest pain, although, administered with intravenous opiates post-operatively. Transthoracic echocardiography was non-diagnostic. Invasive angiography performed emergently showed a thrombotic occlusion of the mid-left anterior descending artery at the site of the anastomosis with the left internal mammary artery (LIMA) graft. Intervention via the graft was considered high risk of complications, therefore, native coronary arteries were used to approach the occlusion, which was successfully cleared with a combination balloon angioplasty with a semi-compliant and then a drug-eluting balloon. The LIMA started working again with the resolution of ST elevation and no immediate complications. Conclusion Early post-operative ST elevations in continuous leads should not be ignored as they often may be the only feature of new-onset ST-elevation myocardial infarction (STEMI). Drug-eluting balloons represent a feasible and possibly safer option than drug-eluting stents to treat these conditions.

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Section: Discussionmentioning

confidence: 99%

Drug-eluting balloon to treat immediate post-coronary artery bypass grafting ST-elevation myocardial infarction: a case report

Shah,

Haider,

Poudyal

et al. 2024

European Heart Journal - Case Reports

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“…KABG cerrahisi sırasında ST-segmentinde, intraoperatif MI nedeniyle olmadığı düşünülen yükselmeler görülebilmektedir. Bu durumun PO dönemde morbidite ve mortalitede artışa neden olmadığı düşünülmektedir (20) . Ancak Rapp ve ark.…”

Section: Discussionunclassified

Comparison of Desflurane and Sevoflurane on Myocardial Protection and Inflammation in Coronary Artery Bypass Surgery

Doğan¹,

Kurtipek²

2021

JARSS

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Çalışmamızda koroner arter bypass greftleme cerrahisi geçirecek hastalarda intraoperatif miyokard iskemisi açısından desfluran ve sevofluran anestezi uygulamalarının ST-segmenti, kardiyak enzim ve TNF-α düzeyleri üzerine etkilerini karşılaştırmayı amaçladık. Yöntem: Elektif koroner arter bypass greftleme cerrahisi planlanan toplam 31 olgu iki gruba randomize edildi ve Grup D'ye desfluran, Grup S'de yer alan hastalara sevofluran anestezik ajan olarak kullanıldı. İntraoperatif dönemde hemodinamik parametreler, ST-segment değişiklikleri, kalp debisi ve kullanılan volatil ajanların minimum alveolar konsantrasyon değerleri takip edildi. Anestezi indüksiyonu öncesi, intraoperatif ve postoperatif belirli dönemlerde alınan kan örneklerinden kardiyak enzim ve tümör nekrotizan faktör-α (TNF-α) ölçümleri yapıldı. Bulgular: Her iki grup arasında kaydedilen hemodinamik parametreler, ST-segment değişikliği ve kalp debisi değerleri arasında farklılık gözlenmedi. Kreatin kinaz-MB ve troponin-T değerlerinde gruplar arasında farklılık bulunmadı. Grup D'de postoperatif 2. saatte ölçülen TNF-α düzeyleri Grup S'ye göre anlamlı olarak daha düşük tespit edildi. Grup S'de cilt kapatıldıktan sonraki ve postoperatif 24. saatte ölçülen TNF-α değerleri Grup D'ye göre daha düşüktü. Sonuç: Desfluran ve sevofluran koroner arter bypass greftleme cerrahisi anestezisinde ST-segment değişikliği, kreatin kinaz-MB ve troponin-T ile belirlenebilen miyokard korunmasını benzer oranda sağlar. Erken postoperatif dönemde desfluran, geç postoperatif dönemde sevofluran TNF-α düzeyleri ile gösterilen inflamasyon yanıtını daha fazla baskılamaktadır. Desfluranın koroner arter bypass greftleme cerrahisinde stabil hemodinami ve miyokard korunması sağlaması ve antiinflamatuar etkileri nedeniyle güvenilir bir volatil anestezik ajan olarak kullanılabileceğini düşünüyoruz.

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“…For instance, the majority of the participants used local guidelines that mention the use of ST segmental changes as ECG criterion for the diagnosis of PMI (64%), while the third universal definition recommends using Q waves and/or new left bundle branch blocks. The use of ST segmental changes is remarkable, as ST‐segment elevations are seen regularly after CABG in the absence of myocardial infarction and are not associated with the peak Tn level or adverse outcomes . A third reason for the lack of (correct) implementation can also be due to indifference toward diagnosing PMI.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosing PMI in cardiac surgery patients is difficult, since pain from the sternal wound and the prescribed opioids may mask the typical symptoms (eg, chest pain, shortness of breath). Furthermore, postoperative changes of the ECG are not uncommon due to direct myocardial damage from the surgery, and postoperative pericarditis . Cardiac‐specific biomarkers, such as creatine‐kinase M‐band and troponin (Tn), are normally used to identify myocardial damage.…”

Section: Introductionmentioning

confidence: 99%

Implementation of the Third Universal Definition of Myocardial Infarction After Coronary Artery Bypass Grafting: A Survey Study in Western Europe

Beek

Zaane

Buijsrogge

et al. 2015

JAHA

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BackgroundDiagnosing a postoperative myocardial infarction in patients undergoing coronary artery bypass grafting is challenging, as the normally used criteria are more difficult to interpret. The rate of implementation of the consensus‐based new diagnostic criteria for postoperative myocardial infarction proposed by the third universal definition of myocardial infarction is unknown. Therefore, the primary objective of this study was to address the implementation of the third universal definition of postoperative myocardial infarction following coronary artery bypass grafting.Methods and ResultsWe conducted a web‐based survey by sending 4 waves of invitations via e‐mail to cardiothoracic surgeons in 12 Western European countries. Of the 302 participating cardiothoracic specialists, from 182 different centers, 213 (71%) were aware that troponin is the preferred biomarker and 112 (37%) knew that using a cut‐off level of >10 times the 99th percentile is recommended. Overall, 90 (30%) participants (strongly) agreed with implementation of this cut‐off level in their clinical practice. Troponin was used in clinical practice by 149 (49%) of the participants. In total, 117 (89%) of the 131 participants with a local guideline confirmed ECG changes as a diagnostic criterion in that guideline. ST segmental changes (75, 64%) were used more often for diagnosing postoperative myocardial infarction than Q waves (64, 55%) or new left bundle branch blocks (34, 29%).ConclusionsCardiac biomarkers and ECG changes were not used in concordance with the third universal definition, and only a minority had a positive attitude toward implementation of the proposed cut‐off level for troponin in their clinical practice.

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Is new ST-segment elevation after coronary artery bypass of clinical importance in the absence of perioperative myocardial infarction?

Cited by 9 publications

References 29 publications

Drug-eluting balloon to treat immediate post-coronary artery bypass grafting ST-elevation myocardial infarction: a case report

Drug-eluting balloon to treat immediate post-coronary artery bypass grafting ST-elevation myocardial infarction: a case report

Comparison of Desflurane and Sevoflurane on Myocardial Protection and Inflammation in Coronary Artery Bypass Surgery

Implementation of the Third Universal Definition of Myocardial Infarction After Coronary Artery Bypass Grafting: A Survey Study in Western Europe

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