Vectorcardiography is superior to conventional ECG for detection of myocardial injury after coronary surgery

OBJECTIVE: The reliability of conventional scalar ECG for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery has been questioned. For the diagnosis of myocardial infarction in general vectorcardiography (VCG) is superior to ECG. Therefore, the usefulness of conventional VCG and computerized analysis of spatial VCG changes for diagnosis of PMI were studied. DESIGN: VCG registrations were obtained from 218 patients undergoing coronary surgery. The spatial QRS vector loop area of each VCG registration was calculated and the loop area before surgery compared with the loop area after surgery. Conventional VCG criteria for myocardial infarction and set values for loop area reduction were related to sustained elevation of plasma troponin-T and clinical course. RESULTS: Both conventional VCG criteria and spatial changes translated better than Q-waves on scalar ECG into elevation of biochemical markers of myocardial injury and impaired clinical course. CONCLUSION: VCG appears superior to conventional ECG as regards detection of myocardial injury in coronary surgery. Computerized programs have facilitated the registration and the interpretation of VCG and this methodology deserves further evaluation in cardiac surgery.     

Scintigraphic demonstration of myocardial perfusion and ischaemia associated with coronary artery bypass grafting

Objectives. To assess if myocardial perfusion scintigraphy (MPS) at rest can be of value in elucidating myocardial perfusion, ischaemia and perioperative myocardial infarction (PMI) associated with coronary artery bypass graft (CABG) surgery. Design. This was a prospective randomized study of patients undergoing elective CABG. Forty-eight patients in the control group underwent serial ECG recordings and measurements of CK-MB and cTnT. Fifty-four patients in the study group were additionally examined with MPS preoperatively and 2–4 days and 6 weeks postoperatively. Results. The study showed a highly significant (p?<?0.001) improvement in myocardial radionuclide uptake from preoperatively to 2–4 days postoperatively. Judged from ECG and enzymatic changes, two control patients and one study patient only had PMI and no additional cases of PMI were demonstrated by MPS. Conclusion. MPS at rest showed that CABG significantly improved myocardial perfusion, by demonstrating an increase in radionuclide uptake. In diagnosing PMI, we found that MPS provided no additional information beyond cardiac biochemical markers and ECG changes.     

Clinical evaluation of perioperative myocardial infarction as a complication of valve replacement

Perioperative myocardial infarction (PMI) is a well-known complication of coronary artery surgery, but rarely encountered in valvular surgery. We have experienced 6 cases of valve replacement with PMI, using blood cardioplegia since 1979. Those patients (5 men, one woman; mean age 47 +/- 8 years) had no previous angina, and preoperative CAG revealed no significant stenosis. Three patients were reoperative cases. A diagnosis of PMI was established by the following criteria; an abnormal increase in maxCPK-MB (greater than 150 IU/l), new Q waves at ECG, positive 99mTc-PYP scan (grade 3-4). The area of PMI was inferior in 4 patients, posterior in one, and anterior infarction was seen in only one case. Three cases required IABP, but all 6 cases showed good exercise capacity by Treadmill exercise test in late stage. Several factors are thought to be the cause of PMI at valvular surgery; such as coronary air embolism, perioperative coronary spasm, inappropriate topical hypothermia, etc. Prognosis is not necessarily poor, however much attention should be paid to prevent PMI in valve replacement.     

Are electrocardiographic Q-wave criteria reliable for diagnosis of perioperative myocardial infarction after coronary surgery?

Objective: A major assumption in cardiovascular medicine is that Q-waves on the electrocardiogram indicate major myocardial tissue damage. The appearance of a new Q-wave has therefore been considered the most reliable criterion for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery. In a study, originally intended to evaluate troponin-T as a marker of PMI, analysis of our data aroused the need to address the reliability of Q-wave criteria for diagnosis of PMI. Methods: In 302 consecutive patients undergoing coronary surgery, Q-wave and other electrocardiogram (ECG) criteria were compared with biochemical markers of myocardial injury and the postoperative course. All ECGs were analysed by a cardiologist blinded to the biochemical analyses and the clinical course. Results: The incidence of positive Q-wave criteria was 8.1%. Combined biochemical (CK-MB≥70 μg/l) and Q-wave criteria were found in 1.0%. Patients with new Q-waves did not have CK-MB or troponin-T levels significantly different from those without Q-waves. More than 25% of the Q-waves were associated with plasma troponin-T below the reference level (<0.2 μg/l) on the fourth postoperative day. Q-wave criteria alone did not influence the postoperative course. In contrast, biochemical markers correlated with clinical outcome. Conclusions: The majority of Q-waves appearing after coronary surgery were not associated with major myocardial tissue damage, and according to troponin-T one-fourth of the Q-waves were not associated with myocardial necrosis. Furthermore, the appearance of Q-waves had little influence on short term clinical outcome. Therefore, the use of Q-wave criteria as the gold standard for diagnosis of PMI may have to be questioned.     

Detection, prediction, and significance of perioperative myocardial infarction following aorta-coronary bypass.

One hundred consecutive patients undergoing aorta-coronary bypass grafting (ACBG) alone, without ventricular venting, were prospectively studied to determine the incidence and consequence of perioperative myocardial infarction (PMI) and the clinical variables that were predictive of PMI. Incidence was determined by serial electrocardiography (ECG) 100 patients; serum CK, GOT, and LDH (100 patients). CK isoenzymes (qualitative 100 patients, quantitated 50 patients); vectorcardiography (VCG) (78 patients); and 99mtechnetium pyrophosphate scintigraphy (TcPyp) (52 patients). The incidence of PMI by ECG was 9%; an additional 8% of cases was diagnosed by enzymes alone. The incidence of diagnostic change by VCG was 19% and by scintigraphy, 25%. Using at least one changed variable of the remaining three as the reference standard, the relative sensitivity and relative specificity of given variables in the diagnosis of PMI were as follows: ECG 67% and 100%, respectively; VCG 85% and 94%; scintigraphy 92% and 97%; and serum enzymes 86% and 96%. By univariate analysis, unstable angina was the only significant predictor of PMI. The operative mortality rate was 2% and the mortality rate at 12 months was 5%. There was a significantly greater mortality rate in patients with PMI diagnosed by ECG (p less than 0.01), in patients with unstable angina pectoris before operation (p less than 0.05), and in women (p less than 0.05).     

Scintigraphic demonstration of myocardial perfusion and ischaemia associated with coronary artery bypass grafting

OBJECTIVES: To assess if myocardial perfusion scintigraphy (MPS) at rest can be of value in elucidating myocardial perfusion, ischaemia and perioperative myocardial infarction (PMI) associated with coronary artery bypass graft (CABG) surgery. DESIGN: This was a prospective randomized study of patients undergoing elective CABG. Forty-eight patients in the control group underwent serial ECG recordings and measurements of CK-MB and cTnT. Fifty-four patients in the study group were additionally examined with MPS preoperatively and 2-4 days and 6 weeks postoperatively. RESULTS: The study showed a highly significant (p < 0.001) improvement in myocardial radionuclide uptake from preoperatively to 2-4 days postoperatively. Judged from ECG and enzymatic changes, two control patients and one study patient only had PMI and no additional cases of PMI were demonstrated by MPS. CONCLUSION: MPS at rest showed that CABG significantly improved myocardial perfusion, by demonstrating an increase in radionuclide uptake. In diagnosing PMI, we found that MPS provided no additional information beyond cardiac biochemical markers and ECG changes.     

Effect of estimated glomerular filtration rate on periprocedural myocardial infarction in patients undergoing elective percutaneous coronary intervention

Abstract

Backgrounds: Little is known about the effect of the estimated glomerular filtration rate (eGFR) on the periprocedural myocardial infarction (PMI). The aim of this study was to determine an eGFR value that is related with PMI development in patients with stable angina undergoing elective percutaneous coronary intervention (PCI). Method: A retrospective analysis was conducted of 257 consecutive PCI patients with stable angina pectoris. The patients were divided into three groups according to eGFR: Group 1: eGFR?>?90?mL/min/1.73?m², Group 2: eGFR?=?60–89?mL/min/1.73?m², and Group 3: eGFR?=?30–59?mL/min/1.73?m². Cardiac biomarkers were measured before, at 8, and at 24?h after the procedure. Results: Periprocedural myocardial infarction occurred in 19% of the study patients. The frequency of PMI was 13.8% in group 1, 15.2% in group 2, and 35% in group 3 (p?=?0.002). There was an inverse relationship with increasing cardiac biomarkers and decreasing eGFR values. Multiple regression analysis showed that an eGFR value between 30 and 59?mL/min/1.73?m² was an independent variable that significantly affected PMI development after PCI. Conclusions: An estimated glomerular filtration rate between 30 and 59?mL/min/1.73?m² is a predictor of developing PMI after elective PCI in patients with stable angina pectoris.     

围术期心肌梗塞的诊疗进展

迄今越来越多的存在心脏高危疾病的患者进行各种手术治疗．由此产生的围术期心肌梗塞（PMI）日益受到关注。依据导致PMI的病理生理机制可以将PMI分为两种类型;1型为围术期出现急性冠脉综合征．2型则是由于在稳定的冠脉病变的基础上（在围手术期间）出现过长时间供氧与耗氧的不平衡而发生的。在围术期对心肌缺血细致严密的监护、在保证血压的基础上严格的控制心率,降低心输出置及预防心脏失代偿的发生,对PMI的预防具有积极的意义。而冠脉血管的外科干预治疗并不是推荐的预防PMI的治疗手段,常规的抗血栓治疗可能加重围术期出血。     

Acute myocardial infarction complicated by shock: outcome analysis based on initial electrocardiogram

Objectives. To assess the relation between initial ECG findings, presence of risk factors, coronary angiography findings, and clinical outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS). Design. Data from a total of 5572 acute myocardial infarction patients admitted to the four tertiary hospitals during a period of 3 years were analyzed. CS on admission was present in 358 patients (6.4%). They were divided into four groups based on the admission ECG: ST-segment elevation (STEMI), ST-segment depression (STDMI), bundle branch block (BBBMI), and other ECG acute myocardial infarction. Results. CS developed most frequently among BBBMI patients (in 12.1% of all BBBMIs, p < 0.001 vs. STEMI), followed by STEMI (6.7%), STDMI (4.4%), and other ECG acute myocardial infarction (2.3%). The risk of CS development was similar in patients with left bundle branch block (LBBB) (13.3%) and right bundle branch block (RBBB) (11.2%). The one-year mortality was highest among RBBBMI patients (66.7%, p < 0.001), followed by LBBBMI (48.6%), other ECG (47.1%), STEMI (41.7%), and STDMI patients (38.1%). Conclusions. RBBB on admission ECG is associated with the highest risk of CS development, frequent left main coronary artery affection, and unsuccessful revascularization. It is also an independent predictor of one-year mortality.     

Early and Delayed Myocardial Infarction after Abdominal Aortic Surgery

Background: Although postoperative myocardial infarction (PMI) after vascular surgery has been described to be associated with prolonged ischemia, its exact pathophysiology remains unclear.

Methods: The authors used intense cardiac troponin I (cTnI) surveillance after abdominal aortic surgery in 1,136 consecutive patients to better evaluate the incidence and timing of PMI (cTnI >= 1.5 ng/ml) or myocardial damage (abnormal cTnI < 1.5 ng/ml).

Results: Abnormal cTnI concentrations was noted in 163 patients (14%), of which 106 (9%) had myocardial damage and 57 (5%) had PMI. In 34 patients (3%), PMI was preceded by a prolonged (> 24 h) period of increased cTnI (delayed PMI), and in 21 patients (2%), the increase in cTnI lasted less than 24 h (early PMI). The mean times from end of surgery to PMI were 37 +/- 22 and 74 +/- 39 h in the early PMI and delayed PMI groups, respectively (P < 0.001). The mean time between the first abnormal cTnI and PMI in the delayed PMI group was 54 +/- 35 h, during which the cTnI profiles of the myocardial damage and delayed PMI groups were identical. In-hospital mortality rates were 24, 21, 7, and 3% for the early PMI, delayed PMI, myocardial damage, and normal groups, respectively.     

Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery

BACKGROUND: Patients undergoing vascular surgical procedures are at high risk for perioperative myocardial infarction (PMI). This study was undertaken to identify predictors of PMI and in-hospital death in major vascular surgical patients. METHODS: From the Vascular Surgery Registry (6,948 operations from January 1989 through June 1997) the authors identified 107 patients in whom PMI developed during the same hospital stay. Case-control patients (patients without PMI) were matched at a 1x:x1 ratio with index cases according to the type of surgery, gender, patient age, and year of surgery. The authors analyzed data regarding preoperative cardiac disease and surgical and anesthetic factors to study association with PMI and cardiac death. RESULTS: By using univariable analysis the authors identified the following predictors of PMI: valvular disease (P = 0.007), previous congestive heart failure (P = 0.04), emergency surgery (P = 0.02), general anesthesia (P = 0.03), preoperative history of coronary artery disease (P = 0.001), preoperative treatment with beta-blockers (P = 0.003), lower preoperative (P = 0.03) and postoperative (P = 0.002) hemoglobin concentrations, increased bleeding rate (as assessed from increased cell salvage; P = 0.025), and lower ejection fraction (P = 0.02). Of the 107 patients with PMI, 20.6% died of cardiac cause during the same hospital stay. The following factors increased the odds ratios for cardiac death: age (P = 0.001), recent congestive heart failure (P = 0.01), type of surgery (P = 0.04), emergency surgery (P = 0.02), lower intraoperative diastolic blood pressure (P = 0.001), new intraoperative ST-T changes (P = 0.01), and increased intraoperative use of blood (P = 0.005). Patients who underwent coronary artery bypass grafting, even more than 12 months before index surgery, had a 79% reduction in risk of death if they had PMI (P = 0.01). Multivariable analysis revealed preoperative definitive diagnosis of coronary artery disease (P = 0.001) and significant valvular disease (P = 0.03) were associated with increased risk of PMI. Congestive heart failure less than 1 yr before index vascular surgery (P = 0. 0002) and increased intraoperative use of blood (P = 0.007) were associated with cardiac death. The history of coronary artery bypass grafting reduced the risk of cardiac death (P = 0.04) in patients with PMI. CONCLUSIONS: The in-hospital cardiac mortality rate is high for patients who undergo vascular surgery and experience clinically significant PMI. Stress of surgery (increased intraoperative bleeding and aortic, peripheral vascular, and emergency surgery), poor preoperative cardiac functional status (congestive heart failure, lower ejection fraction, diagnosis of coronary artery disease), and preoperative history of coronary artery bypass grafting are the factors that determine perioperative cardiac morbidity and mortality rates.     

Early diagnosis and exclusion of acute myocardial infarction by two hours' vector-ECG and determination of either myoglobin or CK-mb. BIOMACS-study. BIOchemical Markers in Acute Coronary Syndromes

This retrospective study assesses the early diagnostic potential of a combination of multilead continuous vectorcardiography (VCG) and biochemical markers (myoglobin, troponin-t and CK-mb mass) in patients with chest pain who present with suspected acute myocardial infarction (AMI), but without ST-elevation on resting 12-lead ECG on admission. Within a multicenter study 56 patients admitted for chest pain (< 12 h) and with a non-diagnostic 12-lead ECG on admission and a VCG recording were included. Venous blood samples were drawn on admission and the continuous VCG was monitored for 2 h. The results were related to the clinical diagnosis of AMI. Neither the biochemical markers nor VCG alone permitted the diagnosis or exclusion of AMI at admission. However, if either analysis of myoglobin on admission or 2 h of VCG recording were positive, they would have a sensitivity for detection of AMI of 100% and specificity of 69%. In a subset of patients with more than 4 h delay since start of chest pain, CK-mb could replace myoglobin and give a sensitivity of 100% and a specificity of 81%. Determination of myoglobin or CK-mb at admission and VCG monitoring for 2 h can reliably confirm or exclude AMI within 2 h. This combination seems useful for early stratifications of patients in chest pain or coronary care units.     

Perioperative Myocardial Infarction in Cardiac Surgery: Risk Factors and Consequences: A Case Control Study

Objective- The aim of the study was to analyze risk factors and clinical outcome in patients sustaining perioperative myocardial infarction (PMI) after cardiac surgery. Design- A retrospective, case control study was conducted, in which 42 patients fulfilling both Q-wave criteria and enzyme criteria for PMI, or autopsy diagnosis, from a cohort of 1147 operated on during the same time period were compared with matched controls. A follow-up by telephone interview was conducted, on average 24 months after the operation. Results- Unstable angina, peripheral vascular disease, short stature and low body weight were more prevalent in the PMI group. Intraoperative remarks of poor quality coronary vessels and incomplete revascularization were more frequent in the PMI group; 30-day mortality was 24% in the PMI group vs 0% in the control group (p &lt; 0.01). The postoperative course was more complicated and protracted in the PMI group. At follow-up, the control group managed significantly better with regard to freedom from angina and the need for nitroglycerine. However, 24 of the 30 survivors in the PMI group reported an improved quality of life after surgery. Conclusions- We found that PMI was mainly associated with coronary surgery and that unstable angina was the most important preoperative risk factor for PMI. Poorer conditions for revascularization may explain some of the infarcts and could also contribute to the impaired long-term outcome in the PMI group.     

Diagnostic criteria and prognosis of perioperative myocardial infarction following coronary bypass

To evaluate the incidence of perioperative myocardial infarction (PMI), serial determinations of serum creatine kinase isoenzymes (CK-MB), electrocardiograms (ECGs), and pyrophosphate myocardial scans were performed in 112 patients undergoing isolated coronary bypass grafting. An abnormal increase in total CK-MB liberation (Q greater than 9.8 IU ml-1 kg) occurred in 25 patients (22.3%), new Q waves were present at ECG in 10 patients (8.9%), and the pyrophosphate myocardial scan was abnormal in 13 patients (11.6%). All tests were negative in 81 patients (72.3%). A diagnosis of PMI was established if confirmed by at least two of the techniques; this diagnosis was made in 15 patients (13.4%). The pattern of CK-MB liberation in patients with a PMI, characterized by a high peak and a prolonged release, was significantly different from that of patients without a PMI. The most important predictive factor for PMI was the duration of myocardial ischemia during the operation. Patients who had a PMI had more frequent early complications, and their prognosis at 2 years showed a 51% probability of remaining free of new cardiac events as compared to 96% for the group of patients without a PMI (p less than 0.001). PMI is not a benign complication of coronary bypass, and its detection appears improved by a combination of diagnostic tests.     

Early identification of permanent myocardial damage after coronary surgery is aided by repeated measurements of CK-MB

OBJECTIVE: ECG diagnosis of myocardial infarction after cardiac surgery is associated with major pitfalls and enzyme diagnosis is interfered by unspecific elevation unrelated to permanent myocardial injury. Sustained release of troponin-T is a marker of permanent myocardial injury if renal function is maintained. However, early identification of perioperative myocardial infarction is desirable and therefore the usefulness of creatine kinase monobasic (CK-MB) kinetics to detect myocardial injury early after coronary surgery was investigated. DESIGN: Two hundred and eighty-six patients undergoing coronary surgery were studied with respect to release of enzymes and troponin-T preoperatively and postoperatively 3 and 8 h after unclamping the aorta, and every morning postoperative days 1-4. RESULTS: CK-MB peak was found at 3 h (n = 145), 8 h (n = 103) and 16-20 h after unclamping (n = 38). Depending on when the CK-MB peak was recorded different demographic and perioperative characteristics were found. A sustained release of troponin-T was characteristic for the group with the CK-MB peak at 16-20 h after unclamping. CONCLUSION: If CK-MB is measured only once it may be advisable to do it on the first postoperative morning as these measurements provided the best discrimination between patients with and without sustained elevation of troponin-T. However, repeated sampling provides additional information that aids in the early identification of permanent myocardial injury particularly in patients with borderline elevations of CK-MB.     

Early and delayed myocardial infarction after abdominal aortic surgery

BACKGROUND: Although postoperative myocardial infarction (PMI) after vascular surgery has been described to be associated with prolonged ischemia, its exact pathophysiology remains unclear. METHODS: The authors used intense cardiac troponin I (cTnI) surveillance after abdominal aortic surgery in 1,136 consecutive patients to better evaluate the incidence and timing of PMI (cTnI > or = 1.5 ng/ml) or myocardial damage (abnormal cTnI < 1.5 ng/ml). RESULTS: Abnormal cTnI concentrations was noted in 163 patients (14%), of which 106 (9%) had myocardial damage and 57 (5%) had PMI. In 34 patients (3%), PMI was preceded by a prolonged (> 24 h) period of increased cTnI (delayed PMI), and in 21 patients (2%), the increase in cTnI lasted less than 24 h (early PMI). The mean times from end of surgery to PMI were 37 +/- 22 and 74 +/- 39 h in the early PMI and delayed PMI groups, respectively (P < 0.001). The mean time between the first abnormal cTnI and PMI in the delayed PMI group was 54 +/- 35 h, during which the cTnI profiles of the myocardial damage and delayed PMI groups were identical. In-hospital mortality rates were 24, 21, 7, and 3% for the early PMI, delayed PMI, myocardial damage, and normal groups, respectively. CONCLUSIONS: Intense postoperative cTnI surveillance revealed two types of PMI according to time of appearance and rate of increase in cTnI. The identification of early and delayed PMI may be suggestive of different pathophysiologic mechanisms. Abnormal but low postoperative cTnI is associated with increased mortality and may lead to delayed PMI.     

Early Diagnosis and Exclusion of Acute Myocardial Infarction by Two Hours' Vector-ECG and Determination of Either Myoglobin or CK-mb

This retrospective study assesses the early diagnostic potential of a combination of multilead continuous vectorcardiography (VCG) and biochemical markers (myoglobin, troponin-t and CK-mb mass) in patients with chest pain who present with suspected acute myocardial infarction (AMI), but without ST-elevation on resting 12-lead ECG on admission. Within a multicenter study 56 patients admitted for chest pain (&lt;12 h) and with a non-diagnostic 12-lead ECG on admission and a VCG recording were included. Venous blood samples were drawn on admission and the continuous VCG was monitored for 2 h. The results were related to the clinical diagnosis of AMI. Neither the biochemical markers nor VCG alone permitted the diagnosis or exclusion of AMI at admission. However, if either analysis of myoglobin on admission or 2 h of VCG recording were positive, they would have a sensitivity for detection of AMI of 100% and specificity of 69%. In a subset of patients with more than 4 h delay since start of chest pain, CK-mb could replace myoglobin and give a sensitivity of 100% and a specificity of 81%. Determination of myoglobin or CK-mb at admission and VCG monitoring for 2 h can reliably confirm or exclude AMI within 2 h. This combination seems useful for early stratifications of patients in chest pain or coronary care units.     

Perioperative myocardial infarction in cardiac surgery--risk factors and consequences. A case control study

OBJECTIVE: The aim of the study was to analyze risk factors and clinical outcome in patients sustaining perioperative myocardial infarction (PMI) after cardiac surgery. DESIGN: A retrospective, case control study was conducted, in which 42 patients fulfilling both Q-wave criteria and enzyme criteria for PMI, or autopsy diagnosis, from a cohort of 1147 operated on during the same time period were compared with matched controls. A follow-up by telephone interview was conducted, on average 24 months after the operation. RESULTS: Unstable angina, peripheral vascular disease, short stature and low body weight were more prevalent in the PMI group. Intraoperative remarks of poor quality coronary vessels and incomplete revascularization were more frequent in the PMI group; 30-day mortality was 24% in the PMI group vs 0% in the control group (p < 0.01). The postoperative course was more complicated and protracted in the PMI group. At follow-up, the control group managed significantly better with regard to freedom from angina and the need for nitroglycerine. However, 24 of the 30 survivors in the PMI group reported an improved quality of life after surgery. CONCLUSIONS: We found that PMI was mainly associated with coronary surgery and that unstable angina was the most important preoperative risk factor for PMI. Poorer conditions for revascularization may explain some of the infarcts and could also contribute to the impaired long-term outcome in the PMI group.     

Stunned myocardium after hip arthroplasty

We report a case of ST-segment elevation occurring in all leads of the ECG during hip arthroplasty. It is thought that this resulted from a stunned myocardium because wall motion abnormalities were reversible, there was no evidence of fixed or vasospastic coronary occlusion and there was only a slight increase in serial cardiac enzymes. Treatment with nicorandil improved the patient's cardiac function. A [123I]MIBG test revealed a high myocardial washout rate, suggesting that the stunned myocardium was caused by exposure to excessive norepinephrine induced by anaesthesia or surgery.      

Coronary artery bypass grafting within 30 days after treatment of acute myocardial infarctions with angioplasty or fibrinolysis – a surgical substudy of DANAMI‐2

Objective—To calculate the incidence and analyse the indications and outcome after surgical revascularization within the first 30 days after randomization of 1572 patients with acute myocardial infarction (MI) associated with ST‐segment elevation (STEMI).

Design—Data regarding the patients undergoing heart surgery within the first 30 days after randomization were collected.

Results—Three patients (0.2%) with acute STEMI and randomized to percutaneous coronary intervention (PCI) underwent emergent coronary artery bypass grafting (CABG). A total of 50 patients (3.2%), 30 in the PCI group and 20 in the fibrinolysis group were revascularized by surgery within the first 30 days after randomization. The most frequent indication for surgery in both groups was unstable angina pectoris, followed by left main stenosis. The incidence of postoperative complications was higher compared with the outcome after elective CABG.

Conclusions—The incidence of emergency CABG in this study was low (0.2%) after treatment of acute MI with either PCI or fibrinolysis. The overall incidence within 30 days was 3.2%, however, the mortality is increased with a 30‐day mortality of 10% in this high‐risk patient group.