Perioperative myocardial infarction in cardiac surgery: Risk factors and consequences - A case control study

Objective-The aim of the study was to analyze risk factors and clinical out come in patients sustaining perioperative myocardial infarction (PMI) after cardiac surgery. Design-A retrospective, case control study was conducted, in which 42 patie nts 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 w ere 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 o f 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 complica ted and protracted in the PMI group. At follow-up, the control group manage d significantly better with regard to freedom from angina and the need for nitroglycerine. However, 24 of the 30 survivors in the PMI group reported a n improved quality of life after surgery. Conclusions-We found that PMI was mainly associated with coronary surgery a nd that unstable angina was the most important preoperative risk factor for PMI. Poorer conditions for revascularization may explain some of the infar cts and could also contribute to the impaired long-term outcome in the PMI group.