Risk and Determinants of Myocardial Injury During Off-Pump Coronary Artery Bypass Grafting
Perioperative myocardial injury (PMI) after coronary revascularization (bypass surgery using cardiopulmonary bypass or percutaneous intervention) is strongly associated with future adverse events, such as death, myocardial infarction, and coronary intervention. The incidence, determinants, and progn...
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| Veröffentlicht in: | The American journal of cardiology 2006-05, Vol.97 (10), p.1482-1486 |
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| container_title | The American journal of cardiology |
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| creator | Nathoe, Hendrik M. Moons, Karel G.M. van Dijk, Diederik Jansen, Erik W.L. Borst, Cornelius de Jaegere, Peter P.T. Grobbee, Diederick E. |
| description | Perioperative myocardial injury (PMI) after coronary revascularization (bypass surgery using cardiopulmonary bypass or percutaneous intervention) is strongly associated with future adverse events, such as death, myocardial infarction, and coronary intervention. The incidence, determinants, and prognostic significance of PMI after bypass surgery without cardiopulmonary bypass (off-pump surgery) are unknown. The study population comprised the patients who were randomized to off-pump surgery in the Octopus Study. PMI was defined by a creatine kinase isoenzyme-MB/total creatine kinase ratio of >5% during the first 48 hours, postoperatively. PMI occurred in 137 of 260 patients (52%). Using multivariate regression analysis, age, female gender, previous myocardial infarction, preoperative nitrate use, preoperative diuretic use, and number of grafts were independently associated with an increased risk of PMI during off-pump surgery. The presence of preoperative coronary collaterals showed a negative association with PMI. The occurrence of PMI had a crude odds ratio of 7.53 (95% confidence interval 1.59 to 35.63) for an adverse cardiac event at 1 year after off-pump surgery. This odds ratio changed little after adjustment for confounders (odds ratio 6.39, 95% confidence interval 1.41 to 28.93). In conclusion, more severe atherosclerotic disease and female gender were associated with an increased risk of perioperative myocardial injury during off-pump bypass surgery, although the presence of coronary collaterals appeared to be protective. Patients with perioperative myocardial injury during off-pump surgery were at a higher risk of adverse cardiac outcomes at 1 year. |
| doi_str_mv | 10.1016/j.amjcard.2005.12.038 |
| format | Article |
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The incidence, determinants, and prognostic significance of PMI after bypass surgery without cardiopulmonary bypass (off-pump surgery) are unknown. The study population comprised the patients who were randomized to off-pump surgery in the Octopus Study. PMI was defined by a creatine kinase isoenzyme-MB/total creatine kinase ratio of >5% during the first 48 hours, postoperatively. PMI occurred in 137 of 260 patients (52%). Using multivariate regression analysis, age, female gender, previous myocardial infarction, preoperative nitrate use, preoperative diuretic use, and number of grafts were independently associated with an increased risk of PMI during off-pump surgery. The presence of preoperative coronary collaterals showed a negative association with PMI. The occurrence of PMI had a crude odds ratio of 7.53 (95% confidence interval 1.59 to 35.63) for an adverse cardiac event at 1 year after off-pump surgery. This odds ratio changed little after adjustment for confounders (odds ratio 6.39, 95% confidence interval 1.41 to 28.93). In conclusion, more severe atherosclerotic disease and female gender were associated with an increased risk of perioperative myocardial injury during off-pump bypass surgery, although the presence of coronary collaterals appeared to be protective. Patients with perioperative myocardial injury during off-pump surgery were at a higher risk of adverse cardiac outcomes at 1 year.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2005.12.038</identifier><identifier>PMID: 16679088</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Age Factors ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular disease ; Coronary Artery Bypass - adverse effects ; Coronary Artery Bypass - methods ; Coronary heart disease ; Coronary vessels ; Creatine Kinase - blood ; Creatine Kinase, MB Form - blood ; Female ; Gender ; Heart ; Humans ; Incidence ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - enzymology ; Myocardial Infarction - epidemiology ; Myocardial Infarction - etiology ; Myocarditis. Cardiomyopathies ; Netherlands - epidemiology ; Prognosis ; Reoperation ; Risk assessment ; Risk Factors ; Sex Factors ; Skin & tissue grafts ; Stroke - enzymology ; Stroke - epidemiology ; Stroke - etiology ; Vascular surgery</subject><ispartof>The American journal of cardiology, 2006-05, Vol.97 (10), p.1482-1486</ispartof><rights>2006 Elsevier Inc.</rights><rights>2006 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. 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The incidence, determinants, and prognostic significance of PMI after bypass surgery without cardiopulmonary bypass (off-pump surgery) are unknown. The study population comprised the patients who were randomized to off-pump surgery in the Octopus Study. PMI was defined by a creatine kinase isoenzyme-MB/total creatine kinase ratio of >5% during the first 48 hours, postoperatively. PMI occurred in 137 of 260 patients (52%). Using multivariate regression analysis, age, female gender, previous myocardial infarction, preoperative nitrate use, preoperative diuretic use, and number of grafts were independently associated with an increased risk of PMI during off-pump surgery. The presence of preoperative coronary collaterals showed a negative association with PMI. The occurrence of PMI had a crude odds ratio of 7.53 (95% confidence interval 1.59 to 35.63) for an adverse cardiac event at 1 year after off-pump surgery. This odds ratio changed little after adjustment for confounders (odds ratio 6.39, 95% confidence interval 1.41 to 28.93). In conclusion, more severe atherosclerotic disease and female gender were associated with an increased risk of perioperative myocardial injury during off-pump bypass surgery, although the presence of coronary collaterals appeared to be protective. Patients with perioperative myocardial injury during off-pump surgery were at a higher risk of adverse cardiac outcomes at 1 year.</description><subject>Age Factors</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Bypass - methods</subject><subject>Coronary heart disease</subject><subject>Coronary vessels</subject><subject>Creatine Kinase - blood</subject><subject>Creatine Kinase, MB Form - blood</subject><subject>Female</subject><subject>Gender</subject><subject>Heart</subject><subject>Humans</subject><subject>Incidence</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - enzymology</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - etiology</subject><subject>Myocarditis. 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Vascular system</topic><topic>Cardiovascular disease</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary Artery Bypass - methods</topic><topic>Coronary heart disease</topic><topic>Coronary vessels</topic><topic>Creatine Kinase - blood</topic><topic>Creatine Kinase, MB Form - blood</topic><topic>Female</topic><topic>Gender</topic><topic>Heart</topic><topic>Humans</topic><topic>Incidence</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - enzymology</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Infarction - etiology</topic><topic>Myocarditis. 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The incidence, determinants, and prognostic significance of PMI after bypass surgery without cardiopulmonary bypass (off-pump surgery) are unknown. The study population comprised the patients who were randomized to off-pump surgery in the Octopus Study. PMI was defined by a creatine kinase isoenzyme-MB/total creatine kinase ratio of >5% during the first 48 hours, postoperatively. PMI occurred in 137 of 260 patients (52%). Using multivariate regression analysis, age, female gender, previous myocardial infarction, preoperative nitrate use, preoperative diuretic use, and number of grafts were independently associated with an increased risk of PMI during off-pump surgery. The presence of preoperative coronary collaterals showed a negative association with PMI. The occurrence of PMI had a crude odds ratio of 7.53 (95% confidence interval 1.59 to 35.63) for an adverse cardiac event at 1 year after off-pump surgery. This odds ratio changed little after adjustment for confounders (odds ratio 6.39, 95% confidence interval 1.41 to 28.93). In conclusion, more severe atherosclerotic disease and female gender were associated with an increased risk of perioperative myocardial injury during off-pump bypass surgery, although the presence of coronary collaterals appeared to be protective. Patients with perioperative myocardial injury during off-pump surgery were at a higher risk of adverse cardiac outcomes at 1 year.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16679088</pmid><doi>10.1016/j.amjcard.2005.12.038</doi><tpages>5</tpages></addata></record> |
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| subjects | Age Factors Biological and medical sciences Cardiology. Vascular system Cardiovascular disease Coronary Artery Bypass - adverse effects Coronary Artery Bypass - methods Coronary heart disease Coronary vessels Creatine Kinase - blood Creatine Kinase, MB Form - blood Female Gender Heart Humans Incidence Logistic Models Male Medical sciences Middle Aged Myocardial Infarction - enzymology Myocardial Infarction - epidemiology Myocardial Infarction - etiology Myocarditis. Cardiomyopathies Netherlands - epidemiology Prognosis Reoperation Risk assessment Risk Factors Sex Factors Skin & tissue grafts Stroke - enzymology Stroke - epidemiology Stroke - etiology Vascular surgery |
| title | Risk and Determinants of Myocardial Injury During Off-Pump Coronary Artery Bypass Grafting |
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