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ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: Peri-operative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery

Matthias Thielmann Vikram Sharma Nawwar Al-Attar Heerajnarain Bulluck Gianluigi Bisleri Jeroen JH Bunge Martin Czerny Péter Ferdinandy Ulrich H. Frey Gerd Heusch ... Show more
European Heart Journal, Volume 38, Issue 31, 14 August 2017, Pages 2392–2411, https://doi.org/10.1093/eurheartj/ehx383
Published: 25 July 2017

Introduction

Coronary artery disease (CAD) is one of the leading causes of death and disability in Europe and worldwide. For patients with multi-vessel CAD, coronary artery bypass graft (CABG) surgery is a common approach for coronary revascularization, and is of proven symptomatic and prognostic benefit. Due to an aging population, higher prevalence of co-morbidities (such as diabetes mellitus, heart failure, hypertension, and renal failure), and a growing requirement for concomitant surgical procedures (such as valve and aortic surgery), higher risk patients are undergoing surgery.1–3 This has resulted in an increased risk of peri-operative myocardial injury (PMI)4 and Type 5 myocardial infarction (MI), both of which are associated with worsened clinical outcomes following CABG surgery. The aetiology and determinants of PMI and Type 5 MI are multi-factorial (see Tables 1 and 2 for summary). Although diagnostic criteria have been proposed for Type 5 MI (based on an elevation in cardiac biomarkers in the 48-h post-operative period and electrocardiogram/angiography/imaging evidence of MI5,13), there is currently no clear definition for prognostically significant PMI, in terms of the level of post-operative cardiac biomarker elevation, which is associated with worsened clinical outcomes following CABG surgery.

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The 3rd Aortic Live Symposium

Dear Colleagues, paying tribute to the explosive development of endovascular techniques along the entire aorta from valve to bifurcation, the 3rd Aortic Live Symposium will present a unique forum offering the best of cardiothoracic and vascular surgery in Essen, Germany.…

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