Postoperative myocardial infarction documented by technetium pyrophosphate scan using single-photon emission computed tomography: significance of intraoperative myocardial ischemia and hemodynamic control

• Published in: Anesthesiology (Philadelphia) 1989-12, Vol.71 (6), p.818-826
• Main Authors: CHENG, D. C. H, CHUNG, F, BURNS, R. J, HOUSTON, P. L, FEINDEL, C. M
• Format: Article
• Language: English
• Subjects: 550601 - Medicine- Unsealed Radionuclides in Diagnostics; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; ARTERIES; Biological and medical sciences; BLOOD VESSELS; BODY; CARDIOVASCULAR DISEASES; CARDIOVASCULAR SYSTEM; COMPUTERIZED TOMOGRAPHY; CORONARIES; Coronary Artery Bypass; Coronary Disease - physiopathology; DIAGNOSIS; DIAGNOSTIC TECHNIQUES; Diphosphates; DISEASES; EMISSION COMPUTED TOMOGRAPHY; ENZYME INHIBITORS; Female; GRAFTS; HEART; Hemodynamics; Humans; Intraoperative Period; ISCHEMIA; ISOTOPES; Male; Medical sciences; Middle Aged; MYOCARDIAL INFARCTION; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - etiology; ORGANS; OXYGEN COMPOUNDS; PATIENTS; PHOSPHORUS COMPOUNDS; Postoperative Complications; PYROPHOSPHATES; RADIOLOGY AND NUCLEAR MEDICINE; Radionuclide Ventriculography; SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY; Technetium; TECHNETIUM ISOTOPES; Technetium Tc 99m Pyrophosphate; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; TOMOGRAPHY; Tomography, Emission-Computed, Single-Photon; TRANSPLANTS; VASCULAR DISEASES
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-198912000-00002

The aim of this prospective study was to document postoperative myocardial infarction (PMI) by technetium pyrophosphate scan using single-photon emission computed tomography (TcPPi-SPECT) in 28 patients undergoing elective coronary bypass grafting (CABG). The relationships of intraoperative electrocardiographic myocardial ischemia, hemodynamic responses, and pharmacological requirements to this incidence of PMI were correlated. Radionuclide cardioangiography and TcPPi-SPECT were performed 24 h preoperatively and 48 h postoperatively. A standard high-dose fentanyl anesthetic protocol was used. Twenty-five percent of elective CABG patients were complicated with PMI, as documented by TcPPi-SPECT with an infarcted mass of 38.0 +/- 5.5 g. No significant difference in demographic, preoperative right and left ventricular function, number of coronary vessels grafted, or aortic cross-clamp time was observed between the PMI and non-PMI groups. The distribution of patients using preoperative beta-adrenergic blocking drugs or calcium channel blocking drugs was found to have no correlation with the outcome of PMI. As well, no significant differences in hemodynamic changes or pharmacological requirements were observed in the PMI and non-PMI groups during prebypass or postbypass periods, indicating careful intraoperative control of hemodynamic indices did not prevent the outcome of PMI in these patients. However, the incidence of prebypass ischemia was 39.3% and significantly correlated with the outcome of positive TcPPi-SPECT, denoting a 3.9-fold increased risk of developing PMI. Prebypass ischemic changes in leads II and V5 were shown to correlate with increased CPK-MB release (P less than 0.05) and tends to occur more frequently with lateral myocardial infarction.