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European Heart Journal 1989 10(9):806-815;
Copyright © 1989 by the European Society of Cardiology.
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© 1989 The European Society of Cardiology

Risk factors for myocardial infarction during coronary artery bypass graft surgery

N. OYSEL*, J. BONNET*,{dagger}, C. VERGNES*, D. BENCHIMOL*, M.-R. BOISSEAU*, C. MOREAU{dagger}, P. BERNADET*,{dagger}, E. BAUDET*, J. LARRUE{dagger} and H. BRICAUD*

*Hôpital Cardiologique du Haut-Lévêque Pessac, France
{dagger}INSERM U8 de Cardiologie, Ave du Haut-Lévêque Pessac, France

Received 2 September 1988; revised 7 February 1989; .

Address for correspondence: Jacques Bonnet, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Pessac, France

Abstract

Patients with a particular thrombotic profile may be at greater risk of myocardial infarction during coronary artery bypass graft surgery.

The thrombotic profile of 50 patients admitted to hospital with stable angina pectoris was determined prior to haemodynamic investigation. ECG results and determination of cardiac enzymes showed that 12 patients had suffered a perioperative myocardial infarction. These patients had a higher mean atherosclerotic score (42.1 ± 10.5 vs 32.9 ± 13, P<0.02), a longer aortic cross clamp time (59 ± 15.2 vs 45.7 ± 16.3 min, P < 0.05), lower serum levels of protein C (101.2±26 vs 124.7+ 31.4%, P<0.05) and tissue plasminogen activator (322 ± 580 vs 2307±2830 IU ml–1, P<0.01).

There were no differences between the two groups in Jenkin's coronary score, the number and type of grafts, ejection fraction, left ventricular end-diastolic pressure, lipid profile or levels of markers of platelet release.

In addition to a more severe distal coronary atheroma and a longer aortic cross-clamp time, patients with impaired endothelial fibrinolytic activity appeared to be at greater risk of myocardial infarction during coronary artery bypass graft surgery.

Key Words: Perioperative myocardial infarction • tissue plasminogen activator • coronary artery disease


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