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Risk factors for fatal myocardial infarction after coronary bypass graft surgery

Published online by Cambridge University Press:  16 August 2006

M. Ranucci ,
A. Frigiola ,
L. Menicanti ,
A. Cazzaniga ,
G. Soro  and
G. Isgrò
M. Ranucci
Affiliation:
Department of Cardiovascular Anesthesia, Cardiovascular Center E. Malan, University of Milan, San Donato Hospital, Milan, Italy
A. Frigiola
Affiliation:
Department of Cardiac Surgery, Cardiovascular Center E. Malan, University of Milan, San Donato Hospital, Milan, Italy
L. Menicanti
Affiliation:
Department of Cardiac Surgery, Cardiovascular Center E. Malan, University of Milan, San Donato Hospital, Milan, Italy
A. Cazzaniga
Affiliation:
Department of Cardiovascular Anesthesia, Cardiovascular Center E. Malan, University of Milan, San Donato Hospital, Milan, Italy
G. Soro
Affiliation:
Department of Cardiovascular Anesthesia, Cardiovascular Center E. Malan, University of Milan, San Donato Hospital, Milan, Italy
G. Isgrò
Affiliation:
Department of Cardiovascular Anesthesia, Cardiovascular Center E. Malan, University of Milan, San Donato Hospital, Milan, Italy
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Abstract

Background and objective The incidence and clinical impact of perioperative myocardial infarction during coronary artery bypass graft surgery vary greatly depending upon the diagnostic criteria applied. Fatal perioperative myocardial infarction has a less arguable diagnosis and clinical impact. The aim of this paper is to find out the risk factors for fatal myocardial infarction after coronary surgery.

Methods Data from 1561 consecutive patients, who underwent coronary revascularization during a 10-month period, have been retrospectively analysed. After an univariate analysis for pre- and intraoperative risk factors, a multivariate model (logistic regression analysis) was settled.

Results Preoperative use of subcutaneous/intravenous heparin, a heparin sensitivity index <1.3 and need for a thromboendarterectomy of the left anterior descending coronary artery are independent risk factors for fatal myocardial infarction. The relative risk for fatal myocardial infarction was about 2 in the case of preoperative heparin use or heparin sensitivity index <1.3 and 5.5 in the case of thromboendarterectomy of the left anterior descending coronary artery.

Conclusions In patients undergoing coronary artery bypass surgery, preoperative anticoagulation management with heparin may represent a risk factor for fatal myocardial infarction. Patterns of heparin resistance, whether or not due to heparin pretreatment, seem to be closely related to fatal myocardial infarction.

Keywords

coronary diseasecardiac surgical proceduresmyocardial revascularizationmyocardial ischaemiamyocardial infarctionglycosaminoglycansheparinanticoagulantsheparinfibrinolytic agentsheparinrisk factors
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 18 , Issue 5 , May 2001 , pp. 322 - 329
Copyright
2001 European Society of Anaesthesiology

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