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

Zangrillo A 1 , Lomivorotov VV 2 , Pasyuga VV 3 , Belletti A 4 , Gazivoda G 5 , Monaco F 4 Show all authors , Nigro Neto C 6 , Likhvantsev VV 7 , Bradic N 8 , Lozovskiy A 9 , Lei C 10 , Bukamal NAR 11 , Silva FS 12 , Bautin AE 13 , Ma J 14 , Yong CY 15 , Carollo C 16 , Kunstyr J 17 , Wang CY 18 , Grigoryev EV 19 , Riha H 20 , Wang C 14 , El-Tahan MR 21 , Scandroglio AM 4 , Mansor M 18 , Lembo R 4 , Ponomarev DN 22 , Bezerra FJL 6 , Ruggeri L 4 , Chernyavskiy AM 22 , Xu J 23 , Tarasov DG 24 , Navalesi P 25 , Yavorovskiy A 26 , Bove T 27 , Kuzovlev A 28 , Hajjar LA 29 , Landoni G 30 , MYRIAD Study Group

Affiliations 

  • 1 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
  • 2 Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Department of Anesthesiology and Intensive Care, Novosibirsk State University, Novosibirsk, Russia
  • 3 Department of Anesthesiology and Intensive Care, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russia
  • 4 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
  • 5 Department of Anaesthesia and Intensive Care, Cardiovascular Institute Dedinje, Belgrade, Serbia
  • 6 Anesthesia Section, Department of Cardiovascular Surgery, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
  • 7 Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia; V. Negovsky Reanimatology Research Institute, Moscow, Russia
  • 8 Department of Cardiovascular Anesthesiology and Intensive Care Medicine, Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia; Department of Biomedical Sciences, University North, Varazdin, Croatia
  • 9 Department of Anesthesia and Intensive Care, Ural Institute of Cardiology, Ekaterinburg, Russia
  • 10 Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xi'an, Shaanxi, China
  • 11 Cardiothoracic ICU and Anesthesia Department, Mohammed Bin Khalifa Cardiac Center, Riffa, Bahrain
  • 12 Department of Anaesthesiology, Hospital de Santa Maria, Lisboa, Portugal
  • 13 Laboratory for Anesthesiology and Intensive Care, Almazov National Medical Research Center, Saint Petersburg, Russia
  • 14 Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
  • 15 Department of Anaesthesiology and Intensive Care, Hospital Pulau Pinang, Pulau Pinang, Malaysia
  • 16 Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
  • 17 Department of Anesthesiology and Intensive Care, First Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
  • 18 Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 19 Intensive Care Unit, Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
  • 20 Cardiothoracic Anesthesiology and Intensive Care Medicine, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
  • 21 Department of Anesthesiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  • 22 Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
  • 23 Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, China
  • 24 Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
  • 25 Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy; Department of Medicine, University of Padua, Padua, Italy
  • 26 Federal Research and Clinical Center of Resuscitation and Rehabilitation, Moscow, Russia
  • 27 Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Central Friuli, Udine, Italy
  • 28 V. Negovsky Reanimatology Research Institute, Moscow, Russia
  • 29 Department of Cardiopneumology, Instituto do Coração, Universidade de São Paulo, São Paulo, Brazil; Intensive Care Unit, Hospital SirioLibanes, São Paulo, Brazil
  • 30 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it
J Cardiothorac Vasc Anesth, 2022 Jan 07.
PMID: 35168907 DOI: 10.1053/j.jvca.2022.01.001

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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