Objective: Unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) still causes significant hospital morbidity and mortality. We evaluated whether surgical outcome can be modified by different myocardial protection strategies. Methods: This was a prospective clinical study conducted in the cardiac surgery units of two university hospitals. Two hundred and sixty-two consecutive patients undergoing CABG for UA/NSTEMI between January 2002 and June 2004 were prospectively divided in three groups: 126 patients underwent on-pump CABG with antegrade blood cardioplegia (Group A); 67 underwent antegrade and retrograde blood cardioplegia (Group B); 69 off-pump CABG (Group C). Hospital outcome was analysed. Differences in outcome variables were detected with ANOVA; Tukey's multiple comparison test and Tamhane's T2 test were used when appropriate. Results: Group A showed higher mortality (P=.001; P=.014 vs. Group B; P=.003 vs. Group C) and perioperative myocardial infarction (P=.001; P=.016 vs. Group B; P=.05 vs. Group C). Hospital stay was shorter in Group B and Group C, compared to Group A (P=.005; P=.043 and P=.05, respectively). Group A required higher doses of inotropes compared to Group B and Group C (P=.0001; P=.0001 and P=.03, respectively), whereas Group B and Group C did not require any inotropic support at all (P=.0001; P=.002 and P=.001 vs. Group A, respectively). Total morbidity was higher in Group A (P=.006; P=.007 vs. Group B; P=.005 vs. Group C). Watt motion score index recovered only in Group B (P=.0001) and Group C (P=.001). Troponin I was higher in Group A at 12 h (P=.0001; P <.001 vs. Group B and Group C), 24 (P=.0001; P=.001 vs. Group B and Group C), 48 (P=.0001; P=.001 vs. Group B, P=.002 vs. Group C) and 72 h (P=.0001; P=.004 vs. Group B; P=.05 vs. Group C). Conclusions: Isolated antegrade cardioplegia should be questioned in UA/NSTEMI. Outcome using off-pump revascutarization was as good as that of combined antegrade and retrograde warm blood cardioplegia. (c) 2005 Elsevier B.V. ALL rights reserved.

Unstable angina and non-ST segment elevation: surgical revascularization with different strategies

Onorati, F;
2005-01-01

Abstract

Objective: Unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) still causes significant hospital morbidity and mortality. We evaluated whether surgical outcome can be modified by different myocardial protection strategies. Methods: This was a prospective clinical study conducted in the cardiac surgery units of two university hospitals. Two hundred and sixty-two consecutive patients undergoing CABG for UA/NSTEMI between January 2002 and June 2004 were prospectively divided in three groups: 126 patients underwent on-pump CABG with antegrade blood cardioplegia (Group A); 67 underwent antegrade and retrograde blood cardioplegia (Group B); 69 off-pump CABG (Group C). Hospital outcome was analysed. Differences in outcome variables were detected with ANOVA; Tukey's multiple comparison test and Tamhane's T2 test were used when appropriate. Results: Group A showed higher mortality (P=.001; P=.014 vs. Group B; P=.003 vs. Group C) and perioperative myocardial infarction (P=.001; P=.016 vs. Group B; P=.05 vs. Group C). Hospital stay was shorter in Group B and Group C, compared to Group A (P=.005; P=.043 and P=.05, respectively). Group A required higher doses of inotropes compared to Group B and Group C (P=.0001; P=.0001 and P=.03, respectively), whereas Group B and Group C did not require any inotropic support at all (P=.0001; P=.002 and P=.001 vs. Group A, respectively). Total morbidity was higher in Group A (P=.006; P=.007 vs. Group B; P=.005 vs. Group C). Watt motion score index recovered only in Group B (P=.0001) and Group C (P=.001). Troponin I was higher in Group A at 12 h (P=.0001; P <.001 vs. Group B and Group C), 24 (P=.0001; P=.001 vs. Group B and Group C), 48 (P=.0001; P=.001 vs. Group B, P=.002 vs. Group C) and 72 h (P=.0001; P=.004 vs. Group B; P=.05 vs. Group C). Conclusions: Isolated antegrade cardioplegia should be questioned in UA/NSTEMI. Outcome using off-pump revascutarization was as good as that of combined antegrade and retrograde warm blood cardioplegia. (c) 2005 Elsevier B.V. ALL rights reserved.
2005
coronary artery bypass surgery
cardiopulmonary bypass
coronary sinus
retrograde perfusion
off-pump
Aged
Analysis of Variance
Angina, Unstable
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Echocardiography
Electrocardiography
Female
Heart Arrest, Induced
Humans
Male
Middle Aged
Myocardial Infarction
Prospective Studies
Treatment Outcome
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1025536
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