TY - JOUR

T1 - Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial

AU - MYRIAD Study Group

AU - Zangrillo, Alberto

AU - Lomivorotov, Vladimir V.

AU - Pasyuga, Vadim V.

AU - Belletti, Alessandro

AU - Gazivoda, Gordana

AU - Monaco, Fabrizio

AU - Nigro Neto, Caetano

AU - Likhvantsev, Valery V.

AU - Bradic, Nikola

AU - Lozovskiy, Andrey

AU - Lei, Chong

AU - Bukamal, Nazar A.R.

AU - Silva, Fernanda Santos

AU - Bautin, Andrey E.

AU - Ma, Jun

AU - Yong, Chow Yen

AU - Carollo, Cristiana

AU - Kunstyr, Jan

AU - Wang, Chew Yin

AU - Grigoryev, Evgeny V.

AU - Riha, Hynek

AU - Wang, Chengbin

AU - El-Tahan, Mohamed R.

AU - Scandroglio, Anna Mara

AU - Mansor, Marzida

AU - Lembo, Rosalba

AU - Ponomarev, Dmitry N.

AU - Bezerra, Francisco José Lucena

AU - Ruggeri, Laura

AU - Chernyavskiy, Alexander M.

AU - Xu, Junmei

AU - Tarasov, Dmitry G.

AU - Navalesi, Paolo

AU - Yavorovskiy, Andrey

AU - Bove, Tiziana

AU - Kuzovlev, Artem

AU - Hajjar, Ludhmila A.

AU - Landoni, Giovanni

N1 - Funding Information: The project was funded by the Italian Ministry of Health (grant No. RF-2010-2318290). Funding Information: The authors thank the MYRIAD Study Group collaborators (by country and city, in alphabetical order):, Australia: Rinaldo Bellomo (Department of Medicine, University of Melbourne, Melbourne). Bahrain: Mahmmod Omar Zaki (Cardiothoracic ICU and Anesthesia Department, Mohammed Bin Khalifa Cardiac Center, Riffa). Brazil: Vinicius Tadeu Nogueira da Silva Nascimento (Anesthesia Section, Department of Cardiovascular Surgery, Dante Pazzanese Institute of Cardiology, S?o Paulo). Bulgaria: Nikolay S. Uvaliev (Anesthesia and Intensive Care, Acibadem City Clinic-Cardiac Surgery Center, Burgas). China: Hui Chi, Duomao Lin, Zhaoqi Wang, Qi Xing (Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing); Zhijian Li (Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha); Yuhua Cheng, Weiqin Huang (Department of Anesthesiology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan). Czech Republic: Petr Kramar (Cardiothoracic Anesthesiology and Intensive Care Medicine, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague). Egypt: Mohammed A. Hegazy (Department of Anaesthesia and Surgical Intensive Care, Mansoura University, Mansoura); Abeer M. Elnakera (Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University Hospital, Zagazig). Italy: Massimo Baiocchi (Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, University Hospital Policlinico S. Orsola, Bologna); Andrea Bruni (Anesthesia and Intensive Care, University Hospital "Mater Domini", Catanzaro; and Department of Medical and Surgical Sciences, University of Magna Graecia, Catanzaro); Maria Grazia Calabr?, Martina Crivellari, Nora Di Tomasso, Marina Pieri (Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan); Luca Severi (Anestesia e Rianimazione, Dipartimento Cardiovascolare, Azienda Ospedaliera San Camillo Forlanini, Rome); Felice E. Agr? (Anesthesia and Intensive Care Department, University Campus Bio-Medico of Rome, Rome); Giuseppe Crescenzi (Anestesia e Terapia Intensiva Cardiochirurgica, Istituto Clinico Humanitas, Rozzano); Luca Brazzi (Department of Anesthesia, Intensive Care and Emergency, Citt? della Salute e della Scienza Hospital, Turin; and Department of Surgical Sciences, University of Turin, Turin). Malaysia: Noorjahan Haneem Hashim (Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur); Jusmidar Abdul Jamil, Maseeda Mohamed Yusof (Department of Anaesthesiology and Intensive Care, Hospital Pulau Pinang, Pulau Pinang); Norzalina Esa, Hanafi Sidik (Department of Cardiothoracic Anaesthesiology and Perfusion, Sarawak Heart Centre, Kota Samarahan, Sarawak); Zuraini Md.Noor, Siti Nurhidayah Rahim (Unit of Cardiothoracic Anaesthesiology and Perfusion, Department of Anaesthesiology and Intensive Care, Hospital Serdang, Kajang, Selangor). Portugal: Ana Ferro, Catarina Barreiros, Ilda Viana (Department of Anaesthesiology, Hospital de Santa Maria, Lisboa). Russia: Ruslan Adzhigaliev, Igor Nudel (Department of Anesthesiology and Intensive Care, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan); Dmitry L. Shukevich (Intensive Care Unit, Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo); Michail Deryagin, Pavel E. Vedernikov, Nikita A. Tarkunov (Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk); Evgeny A. Khomenko (Laboratory for Anesthesiology and Intensive Care, Almazov National Medical Research Center, Saint Petersburg). Saudi Arabia: Ahmed M.G.A. Farag (Department of Anesthesia, King Abdullah Medical City - Holy Capital, KAMC-HC, Makkah). Serbia: Miomir Jovic (Department of Anaesthesia and Intensive Care, Cardiovascular Institute Dedinje, Belgrade; and School of Medicine, University of Belgrade, Belgrade); Jelena Lesanovic, Vladimir Savic (Department of Anaesthesia and Intensive Care, Cardiovascular Institute Dedinje, Belgrade). In addition, the authors thank all of the staff working in operating theaters, intensive care units, and normal wards of participating centers for their support and help during the conduction of this trial. A complete list of the MYRIAD Study Group collaborators is available in Appendix A. The project was funded by the Italian Ministry of Health (grant No. RF-2010-2318290). Publisher Copyright: © 2022 Elsevier Inc.

PY - 2022/8

Y1 - 2022/8

N2 - 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.

AB - 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.

KW - cancer

KW - cardiac surgery

KW - cardioprotection

KW - mortality

KW - myocardial infarction

KW - volatile anesthetics

KW - Anesthetics, Inhalation

KW - Humans

KW - Middle Aged

KW - Anesthetics, Intravenous

KW - Coronary Artery Bypass/methods

KW - Sevoflurane

KW - Myocardial Infarction/drug therapy

KW - Aged

KW - Postoperative Complications/diagnosis

KW - Propofol

UR - http://www.scopus.com/inward/record.url?scp=85124472941&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2022.01.001

DO - 10.1053/j.jvca.2022.01.001

M3 - Article

C2 - 35168907

AN - SCOPUS:85124472941

VL - 36

SP - 2454

EP - 2462

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 8

ER -