Perioperative Myocardial Infarction in Coronary Artery Bypass Surgery

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Abstract
Perioperative myocardial infarction (PMI) as diagnosed by standard electrocardiograms (appearance of persistent Qwaves of at least 0.4 sec duration) and/or autopsy, occurred in 51 (3.8 %) out of 1341 consecutive patients undergoing coronary artery bypass surgery using saphenous vein grafts. Retrospective analysis of the available data revealed that preoperative factors like sex, age, history of myocardial infarction, functional class, coronary risk factors, number of vessels diseased, and ventricular function had no influence on the incidence of PMI. However, intraoperative parameters, e.g., type and durations of cardiac arrest as well as technical errors leading to graft occlusion, significantly affected the incidence of PMI. The clinical relevance of PMI is indicated by a high early mortality of 25.5 % as compared to 2.3 % in patients without PMI. Improvement as well as complete alleviation of angina pectoris was less frequent in patients with PMI than in patients without PMI. The decrease in the rate of PMI from more than 18 % in 1970 to less than 1 % in 1978/79 confirms that such incidents should not be regarded as an inevitable risk but as a complication which can largely be avoided by proper operative technique.

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