Predictors and outcomes of a perioperative myocardial infarction following elective vascular surgery in patients with documented coronary artery disease: results of the CARP trial

Abstract OBJECTIVES In patients with unknown coronary status undergoing surgery for acute infective endocarditis (IE), the need to screen for coronary artery disease (CAD) and the risk of embolization during invasive coronary angiography (ICA) are debated. Coronary computed tomography angiography (CCTA) is a non-invasive alternative in these patients. We aimed to evaluate the safety and feasibility of ICA and CCTA to diagnose CAD, and the necessity to treat CAD to prevent CAD-related postoperative complications. METHODS In this single-centre retrospective cohort study, all patients with acute aortic IE between 2009 and 2019 undergoing surgery were selected. Outcomes were any clinically evident embolization after preoperative ICA, in-hospital mortality, perioperative myocardial infarction or unplanned revascularization and postoperative renal function. RESULTS Of the 159 included patients, CAD status was already known in 14. No preoperative diagnostics for CAD was done in 46/145, a CCTA was performed in 54/145 patients and an ICA in 52/145 patients. Significant CAD was found after CCTA in 22% and after ICA in 21% of patients. In 1 of the 52 (2%) patients undergoing preoperative ICA, a cerebral embolism occurred. The rate of perioperative myocardial infarction or unplanned revascularization in patients not screened for CAD was 2% (1 out of 46 patients). CONCLUSIONS Although the risk of embolism after preoperative ICA is low, it should be carefully weighed against the estimated risk of CAD-related perioperative complications. CCTA can serve as a gatekeeper for ICA in most patients with acute aortic IE.

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Perioperative Myocardial Infarction in Patients with Coronary Artery Disease with and without Aorta-Coronary Artery Bypass Grafts

Survey of Anesthesiology ◽

10.1097/00132586-197910000-00034 ◽

1979 ◽

Vol 23 (5) ◽

pp. 304

Author(s):

L. J. MAHAR ◽

P. A. STEEN ◽

J. H. TINKER ◽

R. E. VLIESTRA ◽

H. C. SMITH ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Coronary Artery Bypass Grafts ◽

Bypass Grafts ◽

Perioperative Myocardial Infarction ◽

Artery Disease

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Diagnosis and management of coronary artery disease in early surgical treatment of acute infective endocarditis of the aortic valve

European Heart Journal ◽

10.1093/ehjci/ehaa946.2028 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

W.G Knol ◽

A.W Wahadat ◽

J.W Roos-Hesselink ◽

W Tanis ◽

A Hirsch ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Infective Endocarditis ◽

Aortic Valve ◽

Perioperative Complications ◽

Invasive Coronary Angiography ◽

Perioperative Myocardial Infarction ◽

Asymptomatic Patients ◽

Artery Disease

Abstract Background The need to routinely screen for coronary artery disease (CAD) in asymptomatic patients undergoing surgery for acute aortic valve infective endocarditis (IE) is debated. There is concern about the risk of embolization during invasive coronary angiography (ICA), especially in patients with vegetations. Coronary computed tomography angiography (cCTA) is a non-invasive alternative. Purpose To evaluate the prevalence of CAD in patients with acute aortic valve IE, the safety and feasibility of ICA and cCTA for diagnosis of CAD, and CAD related postoperative outcomes. Methods In this single center retrospective cohort study, all patients with acute infective aortic valve endocarditis between 2009–2019 undergoing surgery were selected. Outcomes were embolization after preoperative ICA, in-hospital mortality, perioperative myocardial infarction or unplanned revascularization. Results 159 patients (mean age 58±15, 81% male) underwent surgery. No CAD screening was done in 46/145, a cCTA was performed in 54/145 patients and an ICA in 52/145 patients. In 1 of the 52 patients undergoing preoperative ICA a cerebral embolism occurred. cCTA was not assessable on a patient level in 2 patients and 7 patients underwent both cCTA and ICA. Significant CAD was found in about 20% of patients both after cCTA and ICA. Even though just a minority of patients with CAD was treated with concomitant CABG, only 1 patient with known but untreated CAD needed unplanned revascularization postoperatively. The rate of perioperative myocardial infarction or unplanned revascularization in patients not screened for CAD was 5% (3 patients). Conclusion In patients with acute aortic valve IE the prevalence of CAD is low (14%). The risk of embolism after preoperative ICA is not negligible and should be carefully weighed against the estimated risk of CAD-related perioperative complications. cCTA might serve as a gatekeeper for ICA in many patients with acute aortic IE. Funding Acknowledgement Type of funding source: None

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Coronary endarterectomy in myocardial revascularization

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4310 ◽

2021 ◽

Vol 26 (8) ◽

pp. 4310

Author(s):

Ya. Yu. Visker ◽

D. N. Kovalchuk ◽

A. N. Molchanov ◽

O. R. Ibragimov

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Mechanical Ventilation ◽

Coronary Artery ◽

Myocardial Revascularization ◽

Coronary Endarterectomy ◽

Perioperative Myocardial Infarction ◽

Group 2 ◽

Artery Disease ◽

Group 1

Aim. To compare the immediate outcomes of combined coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) and isolated CABG.Material and methods. This retrospective study included 192 patients with stable angina who underwent myocardial revascularization in the period from January 2016 to August 2018. The patients were divided into 2 groups. Group 1 included patients who underwent combined CABG and CE, while group 2 — patients who underwent isolated CABG. Patients in both groups did not differ in the main preoperative characteristics, with the exception of the incidence of obesity and right coronary artery disease.Results. In-hospital mortality in group 1 was 2,2% (n=2), in group 2 — 2% (n=2). The incidence of perioperative myocardial infarction in group 1 was 1% (n=1) and in group 2 — 0%. There were no significant differences between groups in the following postoperative parameters: in-hospital mortality, perioperative myocardial infarction, need and duration of inotropic support, duration of mechanical ventilation (MV) and need for long-term mechanical ventilation, stroke, arrhythmias, resternotomy for bleeding. In group 1, encephalopathy (11,8%) and respiratory failure (12,9%) were significantly more common.Conclusion. Combined CABG and CE is a safe technique for achieving complete myocardial revascularization in diffuse coronary artery disease, since, in comparison with isolated CABG, there is no increase in the incidence of death and perioperative myocardial infarction. However, in this category of patients, an increase in the incidence of non-lethal, non-disabling cerebral and pulmonary complications should be expected.

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