Table 1.

Causes of peri-operative myocardial injury in patients undergoing coronary artery bypass graft surgery

Injury related to primary myocardial ischaemia (mainly graft-related) Plaque rupture in native coronary artery or graft Thrombus formation in the native coronary artery or graft Acute graft failure due to occlusion, kinking, overstretching, anastomotic stenosis or spasm of the grafted blood vessel Arterial graft spasm Myocardial injury related to unfavourable haemodynamics or oxygen supply Tachyarrhythmia Cardiogenic or hypovolaemic shock Severe respiratory failure Severe anaemia Left ventricular hypertrophy Coronary artery or graft micro-embolism Inadequate cardioprotection from cardioplegia Myocardial injury not related to myocardial ischaemia Cardiac handling during surgery Direct injury to the myocardium Surgical myectomy Inflammatory injury due to cardiopulmonary bypass Multifactorial or indeterminate myocardial injury Heart failure Severe pulmonary embolism Sepsis Critically ill patients Renal failure

Adapted from reference 6.