Document Detail


Prognosis of perioperative myocardial infarction after off-pump coronary artery bypass surgery.
MedLine Citation:
PMID:  19734836     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: Perioperative myocardial infarction (PMI) is associated with long-term morbidity and mortality. CKMB cut-off level and importance of Q-wave MI have not been specifically studied after off-pump coronary artery bypass (OPCAB) surgery. The aim of this paper was to study the impact of PMI (CKMB >/= 20 times the upper normal limit [UNL] 100 mg/L) and CKMB rise (5-20 UNL) on survival and recurrent major adverse cardiac event (MACE) after OPCAB surgery. METHODS: One thousand consecutive prospectively followed OPCAB patients operated between September 1996 and March 2004 were analyzed. Follow-up was complete in 97% of the cohort. Average follow-up was 66 +/- 28 months. RESULTS: Overall and cardiac survival at 10 years was 70 +/- 2.6% and 88 + 2.3%, respectively. Evolving MI (EMI) occurred in 1.8%, postoperative non-Q MI (NQMI) in 1.3%, and Q-wave MI (QMI) in 2.0%. Operative mortality was higher in PMI patients (P < 0.001). After adjusting for risk factors, survivors of EMI (HR: 2.0) and QMI (HR: 2.3) but not NQMI had a lower life expectancy and a higher long-term cardiac mortality (EMI: HR: 3.5; QMI: HR: 4.3) compare to non-PMI patients. EMI and QMI were associated with a decrease MACE-free survival. CKMB 5-10 UNL did not affect overall and cardiac mortality. CKMB 10-20 UNL was associated to lower cardiac survival. CONCLUSIONS: PMI (CKMB > 20 UNL) was a strong predictor of operative mortality. QMI and EMI were predictors of long-term mortality and cardiac morbidity after OPCAB surgery. CKMB 10-20 UNL affected long-term cardiac survival but not overall survival.
Authors:
F Vanden Eynden; R Cartier; B Marcheix; P Demers; D Bouchard
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of cardiovascular surgery     Volume:  50     ISSN:  0021-9509     ISO Abbreviation:  J Cardiovasc Surg (Torino)     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-09-07     Completed Date:  2010-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0066127     Medline TA:  J Cardiovasc Surg (Torino)     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  535-43     Citation Subset:  IM    
Affiliation:
Department of Cardiac Surgery, Erasmus Hospital, Free University of Brussels, Brussels, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood
Coronary Artery Bypass, Off-Pump / adverse effects,  mortality*
Creatine Kinase, MB Form / blood*
Electrocardiography
Female
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction / blood,  etiology,  mortality*
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Survival Analysis
Time Factors
Up-Regulation
Chemical
Reg. No./Substance:
0/Biological Markers; EC 2.7.3.2/Creatine Kinase, MB Form

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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