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Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial
A. Zangrillo, VV. Lomivorotov, VV. Pasyuga, A. Belletti, G. Gazivoda, F. Monaco, C. Nigro Neto, VV. Likhvantsev, N. Bradic, A. Lozovskiy, C. Lei, NAR. Bukamal, FS. Silva, AE. Bautin, J. Ma, CY. Yong, C. Carollo, J. Kunstyr, CY. Wang, EV....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, randomizované kontrolované studie
- MeSH
- anestetika inhalační * MeSH
- anestetika intravenózní MeSH
- infarkt myokardu * farmakoterapie epidemiologie MeSH
- koronární bypass metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace diagnóza epidemiologie prevence a kontrola MeSH
- propofol * MeSH
- senioři MeSH
- sevofluran MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
OBJECTIVE: To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). DESIGN: A post hoc analysis of a randomized trial. SETTING: Cardiac surgical operating rooms. PARTICIPANTS: Patients undergoing elective, isolated CABG. INTERVENTIONS: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. MEASUREMENTS AND MAIN RESULTS: A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03). CONCLUSIONS: An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.
5 Negovsky Reanimatology Research Institute Moscow Russia
Cardiothoracic ICU and Anesthesia Department Mohammed Bin Khalifa Cardiac Center Riffa Bahrain
Center for Anesthesiology Beijing Anzhen Hospital Capital Medical University Beijing China
Department of Anaesthesia and Intensive Care Cardiovascular Institute Dedinje Belgrade Serbia
Department of Anaesthesiology and Intensive Care Hospital Pulau Pinang Pulau Pinang Malaysia
Department of Anaesthesiology Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
Department of Anaesthesiology Hospital de Santa Maria Lisboa Portugal
Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan Italy
Department of Anesthesia and Intensive Care Ural Institute of Cardiology Ekaterinburg Russia
Department of Anesthesiology and Intensive Care 1st Moscow State Medical University Moscow Russia
Department of Anesthesiology and Intensive Care Novosibirsk State University Novosibirsk Russia
Department of Anesthesiology and Perioperative Medicine Xijing Hospital Xi'an Shaanxi China
Department of Anesthesiology The 2nd Xiangya Hospital of Central South University Changsha China
Department of Biomedical Sciences University North Varazdin Croatia
Department of Cardiopneumology Instituto do Coração Universidade de São Paulo São Paulo Brazil
Department of Medicine University of Padua Padua Italy
Department of Medicine University of Udine Udine Italy
Federal Research and Clinical Center of Resuscitation and Rehabilitation Moscow Russia
Institute of Anesthesia and Intensive Care Padua University Hospital Padua Italy
Intensive Care Unit Hospital SirioLibanes São Paulo Brazil
School of Medicine Vita Salute San Raffaele University Milan Italy
Citace poskytuje Crossref.org
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- $a Zangrillo, Alberto $u Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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- $a Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial / $c A. Zangrillo, VV. Lomivorotov, VV. Pasyuga, A. Belletti, G. Gazivoda, F. Monaco, C. Nigro Neto, VV. Likhvantsev, N. Bradic, A. Lozovskiy, C. Lei, NAR. Bukamal, FS. Silva, AE. Bautin, J. Ma, CY. Yong, C. Carollo, J. Kunstyr, CY. Wang, EV. Grigoryev, H. Riha, C. Wang, MR. El-Tahan, AM. Scandroglio, M. Mansor, R. Lembo, DN. Ponomarev, FJL. Bezerra, L. Ruggeri, AM. Chernyavskiy, J. Xu, DG. Tarasov, P. Navalesi, A. Yavorovskiy, T. Bove, A. Kuzovlev, LA. Hajjar, G. Landoni, MYRIAD Study Group
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- $a OBJECTIVE: To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). DESIGN: A post hoc analysis of a randomized trial. SETTING: Cardiac surgical operating rooms. PARTICIPANTS: Patients undergoing elective, isolated CABG. INTERVENTIONS: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. MEASUREMENTS AND MAIN RESULTS: A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03). CONCLUSIONS: An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.
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