CURRENT INCIDENCE AND DETERMINANTS OF PERIOPERATIVE MYOCARDIAL-INFARCTION IN CORONARY-ARTERY SURGERY

Increasingly, patients undergoing coronary artery bypass grafting (CAB G) are elders, have had previous CABG, and have poor left ventricular function. To evaluate determinants of perioperative myocardial infarct ion (PMI) after isolated CABG, 499 consecutive patients were reviewed. Definite PMI (total peak creatine kinase [CK] >700 U/L, creatine kina se MB [CK-MB] 230 ng/ml, and new pathologic electrocardiographic Q wav es) occurred in 25 patients (5.0%) and probable PMI (total peak CK >70 0 U/L, CK-MB >30 ng/ml, and a new wall-motion abnormality) occurred in 10 (2.0%) patients. According to multivariate logistic regression ana lysis, independent risk factors for definite or probable PMI (odds rat ios; 95% confidence intervals) were emergency surgery (3.1; 1.1 to 8.4 ; p = 0.003), aortic cross-clamp time >100 minutes (4.2; 1.6 to 11.2; p = 0.004), myocardial infarction in the preceding week (2.6; 1.0 to 6 .4; p = 0.04), and previous revascularization (2.4; 1.1 to 5.2; p = 0. 02). In conclusion, both preoperative and intraoperative factors influ ence the risk of PMI after CABG. Despite changes in the profile of pat ients undergoing CABG, the incidence of PMI in this tertiary center is comparable with that found in earlier series, probably because of imp rovements in surgical techniques and postoperative care.