Risk analysis of coronary bypass surgery after acute myocardial infarction

Lee, Jai H.; Murrell, Helen K.; Strony, John; Cmolik, Brian; Nair, Ravi; Lesnefsky, Edward J.; Chavez, Altagracia M.; vanHeeckeren, Daniel W.; Geha, Alexander S.

doi:10.1016/s0039-6060(97)90073-8

Cited by 28 publications

(18 citation statements)

References 17 publications

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“…Acute myocardial infarction has been clearly demonstrated to be a factor predictive of morbidomortality in cardiac surgery (Lee et al 1997). One of the principal limitations in our present study was the low number of patients studied, as were the low numbers of complications.…”

Section: Discussionmentioning

confidence: 80%

Plasma Troponins as Markers of Myocardial Damage during Cardiac Surgery with Extracorporeal Circulation

Stefano¹,

Casquero²,

Bustamante

et al. 2007

Tohoku J. Exp. Med.

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All types of cardiac surgery involve considerable injury to the myocardium. However, it is difficult to differentiate, in the immediate postoperative state, between ischemic alterations associated with the cardiac surgery itself and the pathological alterations of a peri-operative myocardial infarction. The diagnosis of damaged myocardium, classically performed with the enzymatic markers creatine kinase (CK) and its muscle fraction (CK-MB), has become more precise with the option of measuring cardiac troponins T and I. We measured these markers in 58 patients undergoing elective cardiac surgery with extra-corporeal circulation (ECC). The patients included 37 cases undergoing valve surgery, 14 for coronary revascularization, 6 for mixed procedures, and 1 for closure of an inter-atrial communication. The markers were measured in plasma at baseline (at anesthesia initiation), 5 min post-ECC commencement, following aorta de-clamping, during the surgical closure, and 6, 18 and 42 hrs after surgery. All the markers were increased significantly relative to the baseline values. Troponin I, CK and CK-MB values peaked between 6 and 18 hrs after surgery, troponin T between 18 and 42 hrs, and myoglobin at the surgical closure. The values of all markers were higher in patients undergoing coronary surgery compared to those in patients undergoing valve surgery. In the evaluation of myocardial damage after surgery, the measurement of classical markers such as CK and myoglobin remain valid, but other markers such as troponins provide significant additional diagnostic benefit and, thus, need to be included in the routine biochemical measurements for monitoring myocardial damage associated with the surgical procedure.Peri-operative myocardial damage; injury markers; troponin; creatine kinase; myoglobin

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Section: Discussionmentioning

confidence: 80%

Plasma Troponins as Markers of Myocardial Damage during Cardiac Surgery with Extracorporeal Circulation

Stefano¹,

Casquero²,

Bustamante

et al. 2007

Tohoku J. Exp. Med.

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“…Patients requiring AVR after previous CABG seem to be particularly at risk, possibly due to older age and the presence of left ventricular hypertrophy [15]. Recent myocardial infarction is acknowledged to be an adverse risk factor for early postoperative death after cardiac surgery, however only in patients with unstable angina undergoing CABG [16,17]. To our knowledge, the presented study is the first to combine these separate risk factors into a simple risk score for patients undergoing AVR.…”

Section: Discussionmentioning

confidence: 92%

Predicting 30-day mortality of aortic valve replacement by the AVR score

et al. 2011

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Objectives The objective of this study is to develop a simple risk score to predict 30-day mortality of aortic valve replacement (AVR). Methods In a development set of 673 consecutive patients who underwent AVR between 1990 and 1993, four independent predictors for 30-day mortality were identified: body mass index (BMI) ≥30, BMI <20, previous coronary artery bypass grafting (CABG) and recent myocardial infarction. Based on these predictors, a 30-day mortality risk score-the AVR score-was developed. The AVR score was validated on a validation set of 673 consecutive patients who underwent AVR almost two decennia later in the same hospital. Results Thirty-day mortality in the development set was ≤2% in the absence of any predictor (class I, low risk), 2-5% in the solitary presence of BMI ≥30 (class II, mild risk), 5-15% in the solitary presence of previous CABG or recent myocardial infarction (class III, moderate risk), and >15% in the solitary presence of BMI <20, or any combination of BMI ≥30, previous CABG or recent myocardial infarction (class IV, high risk). The AVR score correctly predicted 30-day mortality in the validation set: observed 30-day mortality in the validation set was 2.3% in 487 class I patients, 4.4% in 137 class II patients, 13.3% in 30 class III patients and 15.8% in 19 class IV patients. Conclusions The AVR score is a simple risk score validated to predict 30-day mortality of AVR.

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“…In a study of 1,181 patients undergoing CABG, the in-hospital mortality rate increased as the patients' preoperative status worsened, ranging from 1.2% in those with stable angina to 26% in those with cardiogenic shock (265).…”

Section: Class Imentioning

confidence: 99%

“…Those undergoing CABG Յ6 hours after symptom onset had a lower in-hospital and long-term (10 years) mortality rate than those undergoing CABG Ͼ6 hours after symptom onset (237). Other studies have provided conflicting results, because of, at least in part, the lack of clear delineation between STEMI and NSTEMI patients in these large database reports (259,265). In an analysis of 9,476 patients hospitalized with an acute coronary syndrome (ACS) who underwent CABG during the index hospitalization, 1,344 (14%) were STEMI patients with shock or intra-aortic balloon placement preoperatively (264).…”

Section: Class Imentioning

confidence: 99%