Myocardial Infarction: An Important Factor for Surgical Decision Making?

Abstract

Background: Recent myocardial infarction has been identified as a risk factor and is currently used as a strong predictor in different scores. The aim of our study was to determine whether the impact of myocardial infarction, especially acute myocardial infarction, is still strong enough to justify a restrictive indication for isolated CABG procedure in patients with significant coronary artery disease. Methods: 10 272 patients underwent isolated CABG at a single institution. A 10-year follow-up was performed with a completeness of 97.2 %. Results: 6 107 (59.5 %) of the patients had a history of myocardial infarction. A stratified Kaplan-Meier analysis demonstrates a significantly worse survival for patients with myocardial infarction (chi-square value: 36.7, p < 0.0001). At a further differentiation for no myocardial infarction (n = 4 165), myocardial infarction > 90 days (n = 4 578), myocardial infarction up to 90 days (recent myocardial infarction) (n = 1 266) and ongoing acute myocardial infarction up to 15 days (n = 263), indicated a higher mortality for the more recent infarction in the univariate analysis. However, if patients with acute myocardial infarction in the past 6 years were analyzed separately, their risk remained at the same level as patients with non-acute myocardial infarction over the total observation period. Furthermore, propensity score matching revealed no statistical significant difference in the outcome of the patients. Conclusions: Structural myocardial damage represents a risk factor for survival after isolated CABG in univariate analysis. More appropriate statistical methods indicate a time-dependent loss of statistically relevant differences between patients with or without myocardial infarction prior to CABG. This is also true for “recent” myocardial infarction which is still part of current scores.

Key words

coronary bypass surgery - myocardial infarction - risk assessment

References

• 1 BQS .KCH Score zur Risikoadjustierung in der isolierten Koronarchirurgie. BQS Qualitätsreport 2006. http://www.bqs-online.com
• 2 Roques F, Nashef S AM, Michel P, Gauducheau E, deVincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones M T, Pinna Pintor P, Salamon R, Thulin L. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19 030 patients.  Eur J Cardiothorac Surg. 1999;  15 816-823
• 3 [no authors listed]. STS risk score. http://66.89.112.110/STSWebRiskCalc261
• 4 Vahl C F, Tochtermann U, Gams E, Hagl S. Efficiency of a computer network in the administrative and medical field of cardiac surgery. Concept and experiences with a departmental system.  Eur J Cardiothorac Surg. 1990;  4 632-638
• 5 Vahl C F, Herold U, Thomas G, Tochtermann U, Schweiger P, Carl I, Hagl S HVMD Study Group and the. Das “Heidelberger Modell”. Krian A, Scheld HH Dokumentationsverfahren in der Herzchirurgie. Darmstadt; Steinkopff Verlag 1995: 35-52
• 6 Ketonen M, Pajunen P, Koukkunen H, Immonen-Räihä P, Mustonen J, Mähönen M, Niemelä M, Kuulasmaa K, Palomäki P, Arstila M, Vuorenmaa T, Lehtonen A, Lehto S, Miettinen H, Torppa J, Tuomilehto J, Airaksinen J, Pyörälä K, Salomaa V. FINMONICA/FINAMI Study Group . Long-term prognosis after coronary artery bypass surgery.  Int J Cardiol. 2008;  124 72-79
• 7 Thielmann M, Massoudy P, Neuhäuser M, Tsagakis K, Marggraf G, Kamler M, Mann K, Erbel R, Jakob H. Prognostic value of preoperative cardiac Troponin I in patients undergoing emergency coronary artery bypass surgery with non-ST-elevation or ST-elevation acute coronary syndromes.  Circulation. 2006;  114 (Suppl. I) I448-I453
• 8 Ladeira R T, Jatene F B, Monteiro R, Zucato S P, Barcaioli L M, Hueb A C, Dallan L A, Puig L B, Oliveira S A, Nicolau J C. Coronary artery bypass grafting in acute myocardial infarction. Analysis of preoperative predictors of mortality.  Arq Bras Cardiol. 2006;  87 254-259
• 9 Stein P K, Domitrovich P P, Huikuri H V, Kleiger R E Cast Investigators for the. Traditional and nonlinear heart rate variability are each independently associated with mortality after myocardial infarction.  J Cardiovasc Electrophysiol. 2005;  16 13-20
• 10 Foody J M, Ferdinand F D, Galusha D, Rathore S S, Masoudi F A, Havranek E P, Nilasena D, Radford M J, Krumholz H M. Patterns of secondary prevention in older patients undergoing coronary artery bypass grafting during hospitalization for acute myocardial infarction.  Circulation. 2003;  108 (Suppl. II) II24-II28
• 11 Hannan E L, Racz M J, Walford G, Ryan T J, Isom O W, Bennett E, Jones R H. Predictors of readmission for complications of coronary artery bypass graft surgery.  JAMA. 2003;  290 773-780
• 12 Tavakoli R, Weber A, Brunner-La Rocca H, Bettex D, Vogt P, Pretre R, Jenni R, Turina M. Results of surgery for irreversible moderate to severe mitral valve regurgitation secondary to myocardial infarction.  Eur J Cardiothorac Surg. 2002;  21 818-824
• 13 Donnan P T, Boyle D IR, Broomhall J, Hunter K, MacDonald T M, Newton R W, Morris A D DARTS/MEMO Collaboration for the. Prognosis following first acute myocardial infarction in type 2 diabetes: a comparative study.  Diabetes Med. 2002;  19 448-455
• 14 Chertow G M, Normand S L, Silva L R, McNeil B J. Survival after acute myocardial infarction in patients with end-stage renal disease: results from the cooperative cardiovascular project.  Am J Kidney Dis. 2000;  35 1044-1051
• 15 Sergeant P, Blackstone E, Meyns B. Early and late outcome after CABG in patients with evolving myocardial infarction.  Eur J Cardiothorac Surg. 1997;  11 848-856
• 16 Kouchoukos M T, Murphy S, Philpott T, Pelate C, Marshall Jr W G. Coronary artery bypass grafting for postinfarction angina pectoris.  Circulation. 1989;  79 168-172
• 17 Lorusso R, LaCanna G, Ceconi C, Borghetti V, Totaro P, Parrinello G, Coletti G, Minzioni G. Long-term results of coronary artery bypass grafting procedure in the presence of left ventricular dysfunction and hibernating myocardium.  Eur J Cardiothorac Surg. 2001;  20 937-948