Abstract
The incidence of perioperative myocardial infarction determined by electrocardiogram was examined in 123 consecutive patients having only coronary artery bypass grafting for unstable angina pectoris, at Yale-New Haven Hospital from January 1974 to June 1975. The incidence of myocardial infarction and its mortality were correlated with clinical, haemodynamic, anatomical, and operative factors. Myocardial infarction occurred in 18% of all patients (22/123); 15 inferior, 6 anterior, and 1 anterolateral wall. Three factors appeared to be related to the occurrence of myocardial infarction: left main coronary artery disease (LMCD), (47%, 7/15), increased left ventricular end-diastolic pressure (LVEDP), (27%, 14/52), and cardiopulmonary bypass time more than 60 minutes (24%, 21/88). The mortality of perioperative myocardial infarcation was 13.6% (3/22), while for patients without perioperative myocardial infarction the mortality was 2% (2/101). The overall operative mortality was 4% (5/123). The risk of perioperative myocardial infarction is significantly increased by left main coronary artery disease, increased left ventricular end-diastolic pressure, and cardiopulmonary bypass time more than 60 minutes, in patients undergoing coronary artery surgery for unstable angina pectoris. The mortality of perioperative myocardial infarction is high (13.6%) in patients with unstable angina.
Full text
PDF





Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Anderson R. P., Rahimtoola S. H., Bonchek L. I., Starr A. The prognosis of patients with coronary artery disease after coronary bypass operations. Time-related progress of 532 patients with disabling angina pectoris. Circulation. 1974 Aug;50(2):274–282. doi: 10.1161/01.cir.50.2.274. [DOI] [PubMed] [Google Scholar]
- Assad-Morell J. L., Frye R. L., CONNOLLY D. C., Gau G. T., Pluth J. R., Barnhorst D. A., WALLACE R. B., Davis G. D., Elveback L. R., Danielson G. K. Relation of intraoperative or early postoperative transmural myocardial infarction to patency of aortocoronary bypass grafts and to diseased ungrafted coronary arteries. Am J Cardiol. 1975 Jun;35(6):767–773. doi: 10.1016/0002-9149(75)90110-1. [DOI] [PubMed] [Google Scholar]
- BLACKBURN H., KEYS A., SIMONSON E., RAUTAHARJU P., PUNSAR S. The electrocardiogram in population studies. A classification system. Circulation. 1960 Jun;21:1160–1175. doi: 10.1161/01.cir.21.6.1160. [DOI] [PubMed] [Google Scholar]
- Bender H. W., Jr, Fisher R. D., Faulkner S. L., Friesinger G. C. Unstable coronary artery disease: comparison of medical and surgical treatment. Ann Thorac Surg. 1975 May;19(5):521–528. doi: 10.1016/s0003-4975(10)64426-8. [DOI] [PubMed] [Google Scholar]
- Berk G., Kaplitt M., Padmanabhan V., Frantz S., Morrison J., Gulotta S. J. Management of preinfarction angina. Evaluation and comparison of medical versus surgical therapy in 43 patients. J Thorac Cardiovasc Surg. 1976 Jan;71(1):110–117. [PubMed] [Google Scholar]
- Bertolasi C. A., Trongé J. E., Carreno C. A., Jalon J., Vega M. R. Unstable angina--prospective and randomized study of its evolution, with and without surgery. Am J Cardiol. 1974 Feb;33(2):201–208. doi: 10.1016/0002-9149(74)90275-6. [DOI] [PubMed] [Google Scholar]
- Brewer D. L., Bilbro R. H., Bartel A. G. Myocardial infarction as a complication of coronary bypass surgery. Circulation. 1973 Jan;47(1):58–64. doi: 10.1161/01.cir.47.1.58. [DOI] [PubMed] [Google Scholar]
- Conti C. R., Brawley R. K., Griffith L. S., Pitt B., Humphries J. O., Gott V. L., Ross R. S. Unstable angina pectoris: morbidity and mortality in 57 consecutive patients evaluated angiographically. Am J Cardiol. 1973 Nov;32(6):745–750. doi: 10.1016/s0002-9149(73)80001-3. [DOI] [PubMed] [Google Scholar]
- DeMots H., Bonchek L. I., Rösch J., Anderson R. P., Starr A., Rahimtoola S. H. Left main coronary artery disease. Risks of angiography, importance of coexisting disease of other coronary arteries and effects of revascularization. Am J Cardiol. 1975 Aug;36(2):136–141. doi: 10.1016/0002-9149(75)90516-0. [DOI] [PubMed] [Google Scholar]
- Espinoza J., Lipski J., Litwak R., Donoso E., Dack S. New Q waves after coronary artery bypass surgery for angina pectoris. Am J Cardiol. 1974 Feb;33(2):221–224. doi: 10.1016/0002-9149(74)90278-1. [DOI] [PubMed] [Google Scholar]
- Gazes P. C., Mobley E. M., Jr, Faris H. M., Jr, Duncan R. C., Humphries G. B. Preinfarctional (unstable) angina--a prospective study--ten year follow-up. Prognostic significance of electrocardiographic changes. Circulation. 1973 Aug;48(2):331–337. doi: 10.1161/01.cir.48.2.331. [DOI] [PubMed] [Google Scholar]
- Geha A. S., Baue A. E., Krone R. J., Kleiger R. E., Oliver G. C., McCormick J. R., Salimi A. Surgical treatment of unstable angina by saphenous vein and internal mammary artery bypass grafting. J Thorac Cardiovasc Surg. 1976 Mar;71(3):348–354. [PubMed] [Google Scholar]
- Greene D. G., Carlisle R., Grant C., Bunnell I. L. Estimation of left ventricular volume by one-plane cineangiography. Circulation. 1967 Jan;35(1):61–69. doi: 10.1161/01.cir.35.1.61. [DOI] [PubMed] [Google Scholar]
- Krauss K. R., Hutter A. M., Jr, DeSanctis R. W. Acute coronary insufficiency. Course and follow-up. Arch Intern Med. 1972 May;129(5):808–813. [PubMed] [Google Scholar]
- McConahay D. R., Killen D. A., McCallister B. D., Arnold M., Reed W. A., Crockett J. E., Bell H. H. Coronary artery bypass surgery for left main coronary artery disease. Am J Cardiol. 1976 May;37(6):885–889. doi: 10.1016/0002-9149(76)90114-4. [DOI] [PubMed] [Google Scholar]
- Najmi M., Ushiyama K., Blanco G., Adam A., Segal B. L. Results of aortocoronary artery saphenous vein bypass surgery for ischemic heart disease. Am J Cardiol. 1974 Jan;33(1):42–48. doi: 10.1016/0002-9149(74)90738-3. [DOI] [PubMed] [Google Scholar]
- Oberman A., Harrell R. R., Russell R. O., Jr, Kouchoukos N. T., Holt J. H., Jr, Rackley C. E. Surgical versus medical treatment in disease of the left main coronary artery. Lancet. 1976 Sep 18;2(7986):591–594. doi: 10.1016/s0140-6736(76)90664-4. [DOI] [PubMed] [Google Scholar]
- Righetti A., Crawford M. H., O'Rourke R. A., Hardarson T., Schelbert H., Daily P. O., DeLuca M., Ashburn W., Ross J., Jr Detection of perioperative myocardial damage after coronary artery bypass graft surgery. Circulation. 1977 Jan;55(1):173–178. doi: 10.1161/01.cir.55.1.173. [DOI] [PubMed] [Google Scholar]
- Rose M. R., Glassman E., Isom O. W., Spencer F. C. Electrocardiographic and serum enzyme changes of myocardial infarction after coronary artery bypass surgery. Am J Cardiol. 1974 Feb;33(2):215–220. doi: 10.1016/0002-9149(74)90277-x. [DOI] [PubMed] [Google Scholar]
- Scanlon P. J., Nemickas R., Moran J. F., Talano J. V., Amirparviz F., Pifarre R. Accelerated angina pectoris. Clinical, hemodynamic, arteriographic, and therapeutic experience in 85 patients. Circulation. 1973 Jan;47(1):19–26. doi: 10.1161/01.cir.47.1.19. [DOI] [PubMed] [Google Scholar]
- Zeft H. J., Manley J. C., Huston J. H., Tector A. J., Auer J. E., Johnson W. D. Left main coronary artery stenosis; results of coronary bypass surgery. Circulation. 1974 Jan;49(1):68–76. doi: 10.1161/01.cir.49.1.68. [DOI] [PubMed] [Google Scholar]
