CONGRESS ABSTRACT

INTRODUCTION:   Perioperative infarction (PMI) after cardiac surgery is a non-rare event requiring complex multidisciplinary management. The Third Universal Definition of MI defines type 5 MI as an elevation of cardiac troponin values ​​>10× 99th percentile during the first 48 h following CABG surgery. PMI often requires coronary angiography after which conservative medical therapy, PCI or surgical re-do may be proposed. Epidemiology and clinical outcomes are poorly known and derive from single-centre case studies. However, it is an event with a high consumption of healthcare resources, hospitalisation in intensive care and the need for further myocardial revascularisation.   METHODS: We conducted a meta-analysis of the 9 studies available in the literature on the subject. The review includes over 100,000 patients undergoing surgery, 1205 of whom underwent coronary angiography for suspected perioperative infarction   RESULTS PMI has a prevalence of 2% among patients undergoing cardiac surgery and a mortality rate of 18%. For every 10,000 patients undergoing surgery, 200 have PMI and 40 die due to this complication. High use of mechanical support (mainly IABP) is reported. In the network meta-analysis, patients undergoing PCI and surgical re-do had less favourable outcomes than conservative medical therapy. In the network meta-analysis, PCI performed better than surgical re-do in terms of mortality.   RESULTS PMI has a prevalence of 2% among patients undergoing cardiac surgery (mainly myocardial revascularisation, isolated CABG 80%) and a mortality rate of 18%. Of every 10,000 patients, 200 patients have PMI and 40 have unfavourable outcomes. In the Network meta-analysis, patients undergoing redo-surgery tended to have more unfavourable outcomes, suggesting the benefit of conservative therapy / PCI in the management of this type of infarction. Interestingly, mechanical support (IABP or ECMO) was required in 30% of patients.   CONCLUSIONS PMI with type 5 myocardial infarction is not an irrelevant epidemiological entity and has high mortality. Treatment is not univocal and requires multidisciplinary management. The topic will be the subject of a dedicated national/international survey to provide further knowledge on PMI.