Pretto Pericles, Martins Gerez Fernandes, Biscaro Andressa, Kruczan Dany David, Jessen Barbara
Hospital São José, Criciúma, SC, Brazil.
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Rev Bras Cir Cardiovasc. 2015 Jan-Mar;30(1):49-54. doi: 10.5935/1678-9741.20140059.
Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized.
To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft.
Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used.
We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases.
The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death.
围手术期心肌梗死对接受冠状动脉旁路移植术患者的预后产生不利影响，其诊断存在诸多困难，因为其病理生理学不同于传统的不稳定型动脉粥样硬化，且临床特征难以明确。
确定接受冠状动脉旁路移植术患者围手术期心肌梗死的发生率及其结局。
在一家三级心脏病专科医院进行回顾性队列研究，研究时间为2011年5月1日至2012年4月30日，纳入所有包含冠状动脉旁路移植术记录的病例。采用心肌梗死的第三次全球定义来确诊围手术期心肌梗死。
我们分析了116例病例。28例患者（24.1%）被诊断为围手术期心肌梗死。移植血管数量、是否使用体外循环以及体外循环时间与该诊断相关，且该组患者的平均年龄显著更高。诊断标准为肌钙蛋白I升高，无论是否诊断为围手术期心肌梗死，99.1%的病例中该指标呈阳性。有或无此并发症的患者在住院时间和重症监护病房停留时间方面未发现显著差异，然而围手术期心肌梗死患者的左心室功能恶化情况更严重，死亡病例更多。
本研究中发现的围手术期心肌梗死发生率较高，因此观察到平均肌钙蛋白I水平更高、左心室功能恶化病例更多以及死亡病例更多。
