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Randomized Controlled Trial
. 2022 Aug;36(8 Pt A):2454-2462.
doi: 10.1053/j.jvca.2022.01.001. Epub 2022 Jan 7.

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

Alberto Zangrillo  1 , Vladimir V Lomivorotov  2 , Vadim V Pasyuga  3 , Alessandro Belletti  4 , Gordana Gazivoda  5 , Fabrizio Monaco  4 , Caetano Nigro Neto  6 , Valery V Likhvantsev  7 , Nikola Bradic  8 , Andrey Lozovskiy  9 , Chong Lei  10 , Nazar A R Bukamal  11 , Fernanda Santos Silva  12 , Andrey E Bautin  13 , Jun Ma  14 , Chow Yen Yong  15 , Cristiana Carollo  16 , Jan Kunstyr  17 , Chew Yin Wang  18 , Evgeny V Grigoryev  19 , Hynek Riha  20 , Chengbin Wang  14 , Mohamed R El-Tahan  21 , Anna Mara Scandroglio  4 , Marzida Mansor  18 , Rosalba Lembo  4 , Dmitry N Ponomarev  22 , Francisco José Lucena Bezerra  6 , Laura Ruggeri  4 , Alexander M Chernyavskiy  22 , Junmei Xu  23 , Dmitry G Tarasov  24 , Paolo Navalesi  25 , Andrey Yavorovskiy  26 , Tiziana Bove  27 , Artem Kuzovlev  28 , Ludhmila A Hajjar  29 , Giovanni Landoni  30 ; MYRIAD Study Group
Affiliations
Randomized Controlled Trial

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

Alberto Zangrillo et al. J Cardiothorac Vasc Anesth. 2022 Aug.

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.

Keywords: cancer; cardiac surgery; cardioprotection; mortality; myocardial infarction; volatile anesthetics.

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Conflict of interest statement

Declaration of Competing Interest V.V.L. received a speaking honorarium from Baxter.

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