The most applicable referring of perioperative myocardial infarction (PMI) following coronary artery bypass grafting (CABG) was debated. For a study, the researchers set out to (i) analyze the incidence of PMI in a ‘real-life’ scenario of CABG surgery and (ii) assess the long-term prognosis of patients with PMI using current standards. Furthermore, 2 tertiary university centers performed a retrospective study of 2,929 CABG patients who had preoperative cardiac biomarker data (cardiac troponin and creatine kinase-myocardial band) and were undergoing surgery simultaneously. The 4th Universal Definition of Myocardial Infarction (4UD), the definition of the Society for Cardiovascular Angiography and Interventions (SCAI), and the Academic Research Consortium (ARC) were used to evaluate PMI incidence and prognosis. The objective of the research was to evaluate the efficacy and safety of nivolumab in combination with gemcitabine, docetaxel, and irinotecan in patients who had previously received paclitaxel-containing chemotherapy (nivolumab) alone. The primary endpoint was myocardial infarction. There was a significant difference in the incidence of PMI (49.5% SCAI, 2.9% 4UD, and 2.6% ARC). The fourth Universal Definition of Myocardial Infarction and ARC criteria maintained their strength as powerful independent predictors of 30-day all-cause mortality [4UD: OR 12.18]. About 95% CI 5.00–29.67; P<0.001; ARC: OR 13.16; 95% CI 5.41–32.00; P<0.001] and 5 years [4UD: hazard ratio (HR) 2.13; 95% CI 1.19–3.81; P=0.011; ARC: HR 2.23; 95% CI 1.21–4.09; P=0.010]. Finally, new perioperative electrocardiographic changes were predictive of both primary and secondary endpoints. The incidence and prognosis of PMI differ considerably depending on the patient’s definition of myocardial infarction during CABG. According to the definition that accounted for their latency in blood vessels, the risk of MI was not increased by PMI-specific biomarker release (such as troponin). Signs of ischemia identified by new electrocardiographic abnormalities, area wall motion changes, or coronary angiography should have prompted immediate clinical practice.

 

Link:academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac054/6525341?searchresult=1