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Effect of volatile anesthetics on myocardial infarction following coronary surgery. A post-hoc analysis of a randomized controlled trialстатья
- Авторы: Zangrillo Alberto, Lomivorotov Vladimir V., Pasyuga Vadim V., Belletti Alessandro, Gazivoda Gordana, Monaco Fabrizio, Neto Caetano Nigro, Likhvantsev Valery V., Bradic Nikola, Lozovskiy Andrey, Lei Chong, Bukamal Nazar A.R., Silva Fernanda Santos, Bautin Andrey E., Ma Jun, Yong Chow Yen, Carollo Cristiana, Kunstyr Jan, Wang Chew Yin, Grigoryev Evgeny V., Riha Hynek, Wang Chengbin, El-Tahan Mohamed R., Scandroglio Anna Mara, Mansor Marzida, Lembo Rosalba, Ponomarev Dmitry N., Lucena Bezerra Francisco Jose ́., Ruggeri Laura, Chernyavskiy Alexander M., Xu Junmei, Tarasov Dmitry G., Navalesi Paolo, Yavorovskiy Andrey, Bove Tiziana, Kuzovlev Artem, Hajjar Ludhmila A., Landoni Giovanni, MYRIAD Study Group for the
- Журнал: Journal of Cardiothoracic and Vascular Anesthesia
- Год издания: 2022
- Издательство: W. B. Saunders Co., Ltd.
- Местоположение издательства: United Kingdom
- DOI: 10.1053/j.jvca.2022.01.001
- Аннотация: Objective: To investigate the effect of volatile anesthetics on rate of postoperative myocardial infarction (MI) and cardiac death following coronary artery bypass graft (CABG).Design: Post-hoc analysis of a randomized trial.Setting: Cardiac surgery theaters.Participants: Patients undergoing elective, isolated CABG.4 Interventions: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane or sevoflurane) or total intravenous anesthesia (TIVA). Primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48h from surgery. Secondary outcome was 1-year death due to cardiac causes. Measurements and Main Results: 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). Mean age was 62±8.4 years, and median baseline ejection fraction was 57 (50-67)%, without differences between the two groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14/2,530 [0.6%] versus 27/2,501 [1.1%] in the TIVA group; p=0.038) and as-treated analyses (16/2,708 [0.6%] versus 29/2,617 [1.1%] in the TIVA group; p=0.039), but not in the intention-to-treat analysis (17/2,663 (0.6%) versus 28/2,667 (1.0%) in the TIVA group; p=0.10). Overall, death due to cardiac causes was lower in the volatile group (23/2,685 [0.9%] versus 40/2,668 [1.5%] 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.Study registration: ClinicalTrials.gov, NCT02105610, Registered 7 April 2014, https://clinicaltrials.gov/ct2/show/NCT02105610.KEY WORDScardioprotection; mortality; myocardial infarction; cancer; cardiac anesthesia; cardiac surgery; sevoflurane; desflurane
- Добавил в систему: Каданцева Кристина Кирилловна