engleski

Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial

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.

cardiac surgery ; cardioprotection ; mortality ; myocardial infarction ; volatile anesthetics.

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