Diagnostic dilemma of perioperative myocardial infarction after coronary artery bypass grafting: A review
Viola Weidenmann, N. Bryce Robinson, Lisa Q. Rong, Irbaz Hameed, Ajita Naik, Mahmoud Morsi, Philippe Grieshaber, Andreas Böning, Leonard N. Girardi, Mario Gaudino
Abstract
Coronary artery bypass grafting (CABG) is one of the most commonly performed cardiac procedures in the United States (US) and Europe. In the US, perioperative morbidity and mortality related to CABG are below 5%. One of the most significant complications following CABG, however, is perioperative myocardial infarction (PMI). Cardiac biomarkers, intra- and post-operative echocardiography, and electrocardiography are routinely used to monitor for evidence of PMI. In this review, we seek to summarize how each of these modalities is used in the clinical setting to differentiate PMI from expected procedure-related changes, and how these findings impact patients' outcomes. We conclude that while no perfect diagnostic test for the detection of clinically meaningful PMI exists, using a combination of existing modalities with knowledge of expected post-procedure changes allows for early and reliable detection. Future development is needed to create more sensitive and specific modalities for the detection of PMI in patients undergoing CABG.