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Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
2002 In: European Heart Journal, Vol. 23, 1219-1227 p.Article in journal (Refereed) Published
Place, publisher, year, edition, pages
2002. Vol. 23, 1219-1227 p.
URN: urn:nbn:se:uu:diva-91588OAI: oai:DiVA.org:uu-91588DiVA: diva2:164373
Available from: 2004-04-19 Created: 2004-04-19Bibliographically approved
In thesis
1. Perioperative Myocardial Damage and Morbidity after Coronary Artery Bypass Grafting
Open this publication in new window or tab >>Perioperative Myocardial Damage and Morbidity after Coronary Artery Bypass Grafting
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this project were to investigate the impact of perioperative myocardial damage on morbidity and mortality after coronary artery bypass grafting (CABG), to determine whether biochemical marker levels after CABG correlate to perioperative myocardial infarct size, and to assess the long-term morbidity after CABG, in particular to determine whether women do worse.

The studies were conducted in patients who had undergone isolated, primary CABG. The correlation of postoperative cardiac marker levels to early and late survival was evaluated in 4,911 consecutive patients; this showed that elevated cardiac markers implied a highly increased risk of both early cardiac death and late death. Hospital readmission for any cause and effect of gender on the readmission rate were analysed in 7,493 patients; it was found that the risk of readmission was higher in women than in men, because of greater co-morbidity and higher age. In the same patient cohort, it was clearly demonstrated that perioperative myocardial damage increased the risk of heart failure independently, and that late mortality was greatly increased in patients readmitted for heart failure. Finally, in a prospective, clinical trial, creatine kinase MB (CK-MB) and troponin I and T levels were found to correlate to infarction mass, as quantified by magnetic resonance imaging postoperatively. The findings strongly suggested that CK-MB above five times the upper normal limit was the result of perioperative myocardial infarction.

In conclusion, perioperative myocardial damage is an important adverse event with a highly negative effect on early and late survival after CABG, and also entails an increased risk of subsequent heart failure, which markedly impairs long-term survival. Gender differences may be explained by patient characteristics and risk factors and not by female sex per se. Increases in biochemical markers after CABG correspond to the amount of perioperatively infarcted myocardium.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2004. 85 p.
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1340
Surgery, coronary surgery, creatine kinase, magnetic resonance imaging, morbidity, mortality, perioperative myocardial infarction, troponin, women, Kirurgi
National Category
urn:nbn:se:uu:diva-4199 (URN)91-554-5931-5 (ISBN)
Public defence
2004-05-14, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala Science Park, Uppsala, 09:15
Available from: 2004-04-19 Created: 2004-04-19Bibliographically approved

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