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Ann Thorac Surg 1980;30:370-377
© 1980 The Society of Thoracic Surgeons

Articles

Perioperative Myocardial Infarction: A Diagnostic Dilemma

Samuel C. Balderman, M.D.*, Joginder N. Bhayana, M.D., Jehuda J. Steinbach, M.D., A.R. Zaki Masud, M.D., Suzanne Michalek, M.S.N.

From the Departments of Thoracic Surgery, Nuclear Medicine, and Cardiology, Veterans Administration Medical Center, and State University of New York at Buffalo, School of Medicine, Buffalo, NY

Accepted for publication March 6, 1980.

* Address reprint requests to Dr. Balderman, Veterans Administration Medical Center, 3495 Bailey Ave, Buffalo, NY 14215

Patients undergoing coronary bypass grafting were studied for incidence of perioperative myocardial infarction (MI) using three modalities: serial electrocardiograms (ECG), serial creatine phosphokinase isoenzymes (MB-CPK), and serial technetium 99m–labeled pyrophosphate scans. A definite perioperative MI was diagnosed if the results were positive in two of the three variables studied. The perioperative infarction rate for the entire group was 8%. The operative mortality was 2.9%. Seven of 8 perioperative MIs were diagnosed by the use of scanning alone. The combination of isoenzyme and ECG analysis diagnosed 5 of 8 perioperative MIs. The MB-CPK and ECG studies were associated with a higher incidence of false-positive diagnoses than myocardial scanning. Patients with perioperative MI had a benign clinical course. Justification for performing three routine 99mTc-pyrophosphate scans on all patients undergoing aortocoronary bypass operation is still to be determined.




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