急性下壁心肌梗死急诊PCI术中应用临时起搏器与阿托品的对比研究

目的：探讨临时起搏器与阿托品在急性下壁心肌梗死急诊经皮冠状动脉介入治疗（PCI）中应用的疗效。方法：入选2012 年2 月至2013 年8 月我院收治的发病12 小时内,诊断为急性下壁心肌梗死并接受急诊PCI治疗的患者92 例,依据治疗方法的不同 将病例分为临时起搏组和阿托品组,并对病例进行为期一年的追踪随访,收集患者平均住院天数、平均住院费用、再灌注心律失 常、心肌梗死后心绞痛、心肌梗死后心衰发生率资料。结果：临时起搏组的平均住院天数、平均住院费用、心肌梗死后心绞痛、心肌 梗死后心衰发生率均显著低于阿托品治疗组（P 均<0.05）,阿托品治疗组的再灌注心律失常发生率则明显低于临时起搏组（P<0. 05）。结论：急性下壁心肌梗死急诊PCI中应用临时起搏器,具有治疗成本低,降低心血管事件发生率的优点,而阿托品治疗在改 善再灌注心律失常的疗效上则显著优于临时起搏治疗。     

Bretylium Tosylate in the Management of Refractory Ventricular Fibrillation

Nine patients who had recurrent ventricular fibrillation following acute myocardial infarction or angina were given bretylium tosylate in a dose of 5 mg./kg. intramuscularly every eight hours after other measures had proved ineffective. Provided the patients were not in shock or in heart failure, there was a considerable reduction in the episodes of ventricular fibrillation.A second group of nine patients who developed recurrent ventricular fibrillation following open heart surgery were given bretylium intravenously, which controlled the arrhythmia in every instance.Bretylium did not completely abolish ventricular premature beats but the latter did not initiate ventricular fibrillation even when they occurred on the T wave.     

ACUTE MYOCARDIAL INFARCTION—A Discussion of Certain Controversial Issues

As a general rule, it is not believed possible to classify patients with acute myocardial infarction as to the future severity of their illness at the time of the initial examination. However, classifications are possible from complete clinical data of the first few days with regard to the predicted mortality rates. Whether to manage the patient in the hospital or at home depends on the community facilities. The patient should be in bed for a period of two to three weeks if unquestioned infarction has occurred.The main avenue of investigation as to lowering of mortality needs to be directed toward the prevention of heart failure or sudden unexpected death probably related to arrhythmia. If the patient is hospitalized and laboratory facilities are available, anticoagulant therapy can be safely and effectively carried out without undue risk or prohibitive increase in the cost of management. The experience of the author and his colleagues has led to the belief that anticoagulants given routinely to patients with myocardial infarction are effective in decreasing the incidence of thromboembolic complications.     

Relation of trauma to disease; aspects of correlation in cases involving compensation

As a general rule, it is not believed possible to classify patients with acute myocardial infarction as to the future severity of their illness at the time of the initial examination. However, classifications are possible from complete clinical data of the first few days with regard to the predicted mortality rates. Whether to manage the patient in the hospital or at home depends on the community facilities. The patient should be in bed for a period of two to three weeks if unquestioned infarction has occurred. The main avenue of investigation as to lowering of mortality needs to be directed toward the prevention of heart failure or sudden unexpected death probably related to arrhythmia. If the patient is hospitalized and laboratory facilities are available, anticoagulant therapy can be safely and effectively carried out without undue risk or prohibitive increase in the cost of management. The experience of the author and his colleagues has led to the belief that anticoagulants given routinely to patients with myocardial infarction are effective in decreasing the incidence of thromboembolic complications.     

Implantable cardioverter defibrillator: an update

Automatic implantable cardioverter defibrillator is now a well established therapy to prevent sudden cardiac death. In secondary prevention (patients with a previous cardiac arrest) defibrillator can be considered as a class I indication, if there is no transient or reversible cause. The level of proof is A. in primary prevention the defibrillator is indicated in coronary artery disease patients with or without symptoms of mild to moderate heart failure (NYHA II or III), an ejection fraction lower than 30 %, measured at least one month after a myocardial infarction and 3 months after a revascularisation, surgery or angioplasty (level of proof B). It is also indicated in symptomatic spontaneous sustained ventricular tachycardias with underlying heart disease (level of proof B), in patients with spontaneous sustained ventricular tachycardia, poorly tolerated, without underlying heart disease for which pharmacological treatment or ablation can not be performed or failed (level of proof B). Finally it is also indicated in patients with syncope of unknown cause with sustained ventricular tachycardia or inducible ventricular fibrillation, with an underlying heart disease (level of proof B). The guidelines proposed by the different societies have also proposed class IIa recommendations which are the following: coronary artery disease patients with left ventricular dysfunction (ejection fraction between 31 or 35 %) measured at least one month after a myocardial infarction and 3 months after a revascularisation with an inducible ventricular arrhythmia. It can be also indicated in idiopathic dilated cardiomyopathies with an ejection fraction lower than 30% and NYHA class II or III. It can be also indicated in familial or inherited conditions with a high risk of sudden cardiac death by ventricular fibrillation without any other efficient known treatment and finally in heart failure patients remaining symptomatic, in class III or IV NYHA, with an optimal medical therapy, an ejection fraction lower than 35 % and a QRS complex duration higher than 120 ms: in this case it is an indication of cardiac resynchronization therapy device associated to the defibrillator. All these class IIa indications have a level of proof B.     

协同护理干预对心肌梗死患者康复及照顾者的生活质量和照顾能力的影响

目的：探讨协同护理对心肌梗死患者康复及照顾着生活质量的护理效果。方法：选取60例心肌梗死患者,随机分为对照组和试验组,各30例。对照组采用常规护理,试验组在对照组的基础上采用协同护理进行干预,观察两组患者在死亡、再梗死、梗死后心绞痛、严重心律失常、心力衰竭等临床并症状及生活自理能力方面的差异,采用总体健康状况量表及照顾能力测量表评价干预前后照顾者生活质量与照顾能力。结果：两组患者生活自理能力无差异（P〉0．05）,试验组梗死后心绞痛的发生率低于对照组（P〈0．05）;试验组照顾者的照顾能力及生活质量显著优于对照组,差异有统计学意义（P〈0．01）。结论：协同护理能明显提高心肌梗死患者照顾者的照顾能力及生活质量,利于患者康复。     

Heart disease as a complication of pregnancy; with emphasis on indications for recommending therapeutic abortion or avoidance of conception

Mere diagnosis of a valvular heart lesion without circulatory incapacity is inconsequential in considering the prognosis for a pregnant woman.There are grave dangers of heart failure during pregnancy, labor or the postpartum period in women who have had congestive failure prior to pregnancy or during a previous pregnancy and delivery. Decisions as to whether or not to recommend avoidance of pregnancy or therapeutic abortion should depend not alone upon the prospect of death during gestation or at the time of delivery, but also upon the possibility of increased impairment of heart function and physical incapacity of the mother in the postpartum period. Because of the extensive surgical procedure there are few indications for interrupting pregnancy after the third lunar month; and because the major circulatory loads do not increase after the eighth month, rarely should labor be prematurely induced after that time.The exertion of labor, although generally inconsequential, in some cases may produce sustained oxygen debt. In cases in which labor in a previous pregnancy has been accompanied by heart failure, cesarean section should be considered as a means of lessening the possibility of serious failure or death, although this is not a frequent consideration. In the resemblance of circulatory changes that occur, during delivery and immediately postpartum, to those changes produced by the closure of an arteriovenous shunt or patent ductus arteriosus, lies a suggestion as to some of the causative factors in heart failure during or soon after delivery. Probably of great importance is the decrease in blood volume and hemoconcentration at delivery followed by the return of water to the circulatory system, with consequent transient increase in blood volume, in the postpartum period. Additionally, the rise of venous pressure after use of oxytocic drugs suggests that rapid infusion of blood from an engorged uterus may cause an abrupt and perhaps poorly tolerated hypervolemia. Death by heart failure in pregnancy and the puerperium has become extremely rare in recent years due to the frequent observations, meticulous diagnosis of impending failure and improved care of cardiac patients jointly by the obstetrician and the internist. In addition to digitalis therapy and sodium restriction, patients exhibiting evidence of impending heart failure may require bed rest through the entire third trimester of pregnancy. Oxygen should be administered during labor in such patients and anoxia guarded against during anesthesia.     

ATLAS OF ROENTGENOGRAPHIC POSITIONS

Mere diagnosis of a valvular heart lesion without circulatory incapacity is inconsequential in considering the prognosis for a pregnant woman.There are grave dangers of heart failure during pregnancy, labor or the postpartum period in women who have had congestive failure prior to pregnancy or during a previous pregnancy and delivery.Decisions as to whether or not to recommend avoidance of pregnancy or therapeutic abortion should depend not alone upon the prospect of death during gestation or at the time of delivery, but also upon the possibility of increased impairment of heart function and physical incapacity of the mother in the postpartum period.Because of the extensive surgical procedure there are few indications for interrupting pregnancy after the third lunar month; and because the major circulatory loads do not increase after the eighth month, rarely should labor be prematurely induced after that time.The exertion of labor, although generally inconsequential, in some cases may produce sustained oxygen debt. In cases in which labor in a previous pregnancy has been accompanied by heart failure, cesarean section should be considered as a means of lessening the possibility of serious failure or death, although this is not a frequent consideration.In the resemblance of circulatory changes that occur, during delivery and immediately postpartum, to those changes produced by the closure of an arteriovenous shunt or patent ductus arteriosus, lies a suggestion as to some of the causative factors in heart failure during or soon after delivery. Probably of great importance is the decrease in blood volume and hemoconcentration at delivery followed by the return of water to the circulatory system, with consequent transient increase in blood volume, in the postpartum period. Additionally, the rise of venous pressure after use of oxytocic drugs suggests that rapid infusion of blood from an engorged uterus may cause an abrupt and perhaps poorly tolerated hypervolemia.Death by heart failure in pregnancy and the puerperium has become extremely rare in recent years due to the frequent observations, meticulous diagnosis of impending failure and improved care of cardiac patients jointly by the obstetrician and the internist. In addition to digitalis therapy and sodium restriction, patients exhibiting evidence of impending heart failure may require bed rest through the entire third trimester of pregnancy. Oxygen should be administered during labor in such patients and anoxia guarded against during anesthesia.     

High incidence of cardiovascular complications in pheochromocytoma

Excess of catecholamines in pheochromocytoma is usually accompanied with classical symptoms and signs. In some cases, severe cardiovascular complications (e. g., heart failure, myocardial infarction) may occur. We performed a retrospective analysis focused on the incidence of cardiovascular complications (classified as follows: arrhythmias, myocardial involvement or ischemia and atherosclerosis, cerebrovascular impairment) before the establishment of diagnosis of pheochromocytoma among 145 subjects treated in our hospital. Cardiovascular complications occurred in 28 subjects, but these subjects did not differ significantly from subjects without complications in age, gender, body mass index, paroxysmal symptoms, symptom duration, tumor dimension, catecholamine secretory phenotype, and incidence of hypertension or diabetes mellitus. Arrhythmias occurred in 15 subjects (2 arrhythmia types in 2 subjects): atrial fibrillation in 9 subjects, supraventricular tachycardia in 3 cases, and ventricular tachycardia in 2 patients. Significant bradycardia was noted in 3 cases. Five subjects presented with heart failure with decreased systolic function (takotsubo-like cardiomyopathy found in 2 cases). One subject suffered from hypertrophic obstructive cardiomyopathy. Seven subjects presented with non-ST-segment elevation myocardial infarction, 2 patients with ST-segment myocardial infarction, and 1 subject underwent coronary artery bypass grafting. Two subjects suffered from significant peripheral atherosclerosis. Among cerebrovascular complications, transient ischemic attack was found in 3 cases, 2 subjects suffered from stroke, and subarachnoidal bleeding occurred in 1 patient. One subject suffered from diffuse neurological impairment due to multiple ischemic white matter lesions. These data show relatively high incidence of cardiovascular complications (19.3%) in subjects with pheochromocytoma. Early diagnosis is mandatory to prevent severe complications in pheochromocytoma.     

老年急性心肌梗死并心源性休克冠状动脉介入治疗的临床效果分析

目的:对比分析介入治疗和保守治疗对急性心梗合并心源性休克的老年患者的治疗效果。方法:回顾性分析急性心肌梗死并心源性休克患者,共入选230例,按照医生评估进行分组治疗,分为介入治疗组和非介入治疗组,介入组患者120例,接受冠脉介入治疗;非介入组患者110例,接受非介入治疗。对比分析危险因素以及治疗效果。结果:介入组中心肌梗死病史及心衰病史患者明显高于非介入组(24.2%vs 20%P<0.05;25%vs 17.3%,P<0.05),经皮冠状动脉介入治疗与非介入治疗相比能显著降低急性心梗合并心源性休克的老年患者住院病死率(40.8%vs 71.8%,P<0.05),非介入治疗组心律失常发生率高于介入治疗组(26.7%vs 21.8%,P<0.05),同时非介入治疗组肺部感染及肾衰的发病率较高(11.8%vs 5.8%P<0.05;8.2%vs 2.0%,P<0.05)。结论:针对急性心梗合并心源性休克的老年患者制定治疗方案时,虽然介入治疗存在更多的并发症,但是可以显著改善患者预后。     

Mechanisms of enhanced shock-induced arrhythmogenesis in the rabbit heart with healed myocardial infarction

Shock-induced vulnerability and defibrillation have been mostly studied in structurally normal hearts. However, defibrillation therapy is normally applied to patients with diseased hearts, frequently those with prior myocardial infarction (MI). Shock-induced vulnerability and defibrillation have not been well studied under this condition. We sought to examine the mechanisms of shock-induced arrhythmogenesis and arrhythmia maintenance in a rabbit model of healed MI (4 wk or more postinfarction). Ligation of the lateral division or posterolateral division of the left coronary artery at a level of 40-70% from the apex was performed 53 +/- 21 days before acute experiments. Shock-induced vulnerability was assessed in infarcted (n = 8) and structurally normal (n = 8) hearts by delivering internal monophasic shocks at different shock strengths and delivery phases. Electrical activities from the anterior epicardium during shock application and during shock-induced arrhythmias were optically recorded and quantitatively analyzed. Ligation resulted in a transmural left ventricular free wall infarction mainly located at the apical region with a consistent endocardial border zone (BZ) as confirmed by histological studies. There were significant increases in the incidence, severity, and duration of shock-induced arrhythmias in the infarcted hearts versus controls due to 1) postshock break-excitation wavefronts that frequently originated near the infarction BZ and 2) the existence of an infarction BZ that created an anatomic reentry pathway and facilitated arrhythmia maintenance. In conclusion, the infarction BZ contributes to both increased shock-induced arrhythmogenesis and arrhythmia maintenance in the rabbit model of healed MI.     

80例急性心肌梗死患者心电监护及护理

目的总结急性心肌梗死患者心电监护及护理经验。方法对本院性心肌梗死患者及时进行心电监护,对出现的心律失常者进行对症处理。结果本组80例患者中出现心律失常55例,其中室性心律失常48例,临床治愈45例;出现心室颤动7例,4例及时电复律转为窦性心律,3例抢救无效死亡。本组心律失常均发生在心肌梗死后1周内,尤其是发病24小时内,出现最多。结论心律失常是心肌梗死患者常见的并发症,也是患者死亡的主要原因,持续心电监护对患者心律失常的及时发现、明确诊断、指导抢救有重要意义。     

n-3 Fatty acids, cardiac arrhythmia and fatal coronary heart disease

n-3 Polyunsaturated fatty acids (n-3 PUFA) are suggested to prevent cardiac death via inhibition of cardiac arrhythmia. In this review we discuss the results of human studies on intake of n-3 PUFAs and heart disease and, more specifically, on cardiac arrhythmia. Observational studies indicate that intake of fish is associated with a lower incidence of fatal coronary heart disease in several populations. These studies are fairly consistent, but people that have a high intake of fatty fish might have a healthier lifestyle in general, and such confounding is difficult to remove completely with statistical adjustments and corrections. Evidence from trials is less clear. In two open label trials in patients with a previous myocardial infarction intake of fish or fish oil prevented fatal coronary heart disease. In contrast, a trial in patients with angina suggested a higher risk of sudden cardiac death in patients taking fish oil. Furthermore, results of trials in patients with an implantable cardioverter defibrillator (ICD) that investigated effects of fish oil on arrhythmia in patients already suffering from ventricular tachycardia are not consistent. Also, studies on relationships between intake of n-3 PUFA from fish and less life-threatening forms of arrhythmia, such as atrial fibrillation and premature ventricular complexes (PVCs) are equivocal. Thus, after 35 years of research the question whether fish prevents heart disease remains unanswered, and an anti-arrhythmic effect of fish oil remains unproven although the idea is still viable and is being actively tested in further trials.     

Départ imprévu en CEC

The cardio pulmonary bypass (CPB) is used in heart surgery for circulatory and respiratory replacement. The effectiveness of this technique, as well circulatory as respiratory goes and will go to spread its use far beyond the strictly surgical field. The unexpected starts on CPB include not provided starts, anticipated stars, and renewed stars. The not provided starts concern going on CPB for a cardiac or respiratory failure, not reacting to the conventional techniques of cardiopulmonary resuscitation and rare cases of inability to access the airway in emergency. This could be an exceptional complement to external cardiac massage. The anticipated departures involve patients in the operating room for cardiac surgery for which the establishment of the CPB has to treat with emergency life threatening brutal cardiac failure on valvular or coronary artery disease. The renewed starts are being on CPB or after weaning of CPB. It is being CPB to change a failed oxygenator responsible for a tissue hypoxia or replace a piece of tube main circuit of the CPB. A new start on CPB after weaning is essentially for circulatory assistance made necessary by postcardiotomy heart failure, by side effects of protamine injection, excessive bleeding or intra cardiac thrombosis. The oxygenator replacement techniques in emergency are exposed. This techniques demand a well trained and mobile medical and para medical staff.     

Late Ventricular Dysrhythmias after Myocardial Infarction

Serious ventricular dysrhythmias occurred in hospital after discharge from a coronary intensive care unit in 11 out of 142 patients with myocardial infarction. Previous rhythm changes, hypotension, and left ventricular failure were common findings; only one of these patients had an uneventful previous course. Four patients were resuscitated and left hospital; six were resuscitated but died at varying periods up to eight days after the event; one patient could not be resuscitated. Recent coronary occlusion or further myocardial infarction was demonstrated in 7 of these 11 patients and presumably accounted for the dysrhythmia.     

血清Trx1、FGL2与急性心肌梗死后心力衰竭患者预后的关系

摘要 目的：探讨血清硫氧还蛋白1（Trx1）、纤维蛋白原样蛋白2（FGL2）与急性心肌梗死后心力衰竭患者预后的关系。方法：选择2019年10月至2020年5月我院收治的158例急性心肌梗死后心力衰竭患者作为观察组,并根据心功能Killip分级分为Ⅱ级组54例、Ⅲ级组57例、Ⅳ级组47例。另选择同期我院收治的102例急性心肌梗死患者作为对照组。入院后采用酶联免疫吸附法（ELISA）检测所有患者血清Trx1、FGL2水平;观察组患者出院后随访2年,并根据是否出现主要不良心血管事件（MACE）将患者分为预后不良组和预后良好组。采用多因素Logistic回归分析影响急性心肌梗死后心力衰竭患者预后的相关因素,采用受试者工作特征（ROC）曲线评估血清Trx1、FGL2对急性心肌梗死后心力衰竭患者预后的预测价值。结果：观察组血清FGL2水平明显高于对照组,血清Trx1水平明显低于对照组（P<0.05）;心功能Killip分级Ⅳ级组患者血清Trx1水平明显低于Ⅱ级组、Ⅲ级组（P<0.05）,血清FGL2水平明显高于Ⅱ级组、Ⅲ级组（P<0.05）。预后不良组患者血清Trx1、LVEF均明显低于预后良好组,而年龄、血清FGL2及血尿酸、血肌酐、N末端B型利钠肽原（NT-proBNP）均明显高于预后良好组（P<0.05）,两组心功能Killip分级比例比较差异有统计学意义（P<0.05）。多因素Logistic回归分析显示,年龄（较高）、心功能Killip分级为Ⅳ级、Trx1下降、FGL2升高均是影响急性心肌梗死后心力衰竭患者预后的危险因素（P<0.05）。ROC曲线结果显示,血清Trx1、FGL2预测急性心肌梗死后心力衰竭患者预后的曲线下面积分别为0.807、0.811,两者联合检测预测急性心肌梗死后心力衰竭患者预后的曲线下面积为0.889。结论：急性心肌梗死后心力衰竭患者血清中Trx1水平降低,FGL2水平升高,且血清Trx1、FGL2水平与患者心功能分级及预后密切相关,可作为评估急性心肌梗死后心力衰竭患者预后的辅助性指标。     

Comparison of Mobilization after Two and Nine Days in Uncomplicated Myocardial Infarction

A total of 189 patients with uncomplicated myocardial infarction were selected at random for early or late mobilization and discharge from hospital. Patients were admitted to the study after 48 hours in a coronary care unit if they were free of pain and showed no evidence of heart failure or significant dysrhythmia. Randomization was achieved by monthly cross-over of the three medical wards to which the patients were discharged. One group of patients was mobilized immediately and discharged home after a total of nine days in hospital, and the second group was mobilized on the ninth day and discharged on the 16th day. Out-patient assessment was carried out six weeks after admission. No significant differences were observed between the groups in terms of mortality or morbidity, as reflected by the incidence of recurrent chest pain or myocardial infarction, heart failure, dysrhythmia, or venous thromboembolism detected either clinically or by ¹²⁵I-labelled fibrinogen scanning.     

室性心律失常相关神经机制的研究进展

室性心律失常是常见的心血管系统疾病,指起源于心室的心律紊乱,其发病率高,严重影响人类健康。目前认为,器质性与非器质性心脏病引发的室性心律失常与神经功能调节密切相关,特别是中枢神经的调节作用;心力衰竭及心肌梗死引起的心律失常与神经内分泌系统紊乱相关;脑损伤或应激创伤引起的室性心律失常与自主神经所控制的区域有关。室性心律失常的电风暴属于临床急性危重性症候群,可引起严重的血流动力学障碍,通常需要采取电复律或电除颤进行紧急治疗,而该症状的主要的促发因素被认为是过度兴奋的交感神经状态。随着研究和临床实践的不断深入,我们对室性心律失常的发生机制会形成更加系统的认识,这对疾病防治手段的完善具有积极的意义。     

Relative hyperglycemia is associated with complications following an acute myocardial infarction: a post-hoc analysis of HI-5 data

Background

Hyperglycemia is associated with increased morbidity and mortality in patients with an acute myocardial infarction (AMI). We evaluated whether complications after AMI are associated with absolute or relative glycemia.

Methods

A total of 192 patients with AMI were randomized to intensive or conventional insulin therapy. Absolute glycemia was defined as mean blood glucose level (BGL) during the first 24 h following randomization. Relative glycemia was defined by the stress hyperglycaemia ratio (SHR), calculated as mean BGL divided by average glucose concentration over the prior 3 months estimated from glycosylated haemoglobin. The primary endpoint was a “complicated AMI”, defined as an AMI complicated by death, congestive cardiac failure, arrhythmia, cardiac arrest, reinfarction, cardiogenic shock, inotrope use or emergency revascularization.

Results

There was not a significant association between mean BGL and complicated AMI (odds ratio (OR) 1.05 per mmol/L glucose increment, 95% confidence intervals (CI) 0.93–1.19). In contrast, SHR was positively associated with a complicated myocardial infarction (OR 1.22 per 0.1 SHR increment, 95% CI 1.06–1.42), and individual complications of death (OR 1.55, 95% CI 1.14–2.11), congestive cardiac failure (OR 1.27, 95% CI 1.05–1.54), arrhythmia (OR 1.31, 95% CI 1.12–1.54) and cardiogenic shock (OR 1.42, 95% CI 1.03–1.97). The relationship between SHR and a complicated AMI was independent of diabetic status, intensive insulin therapy, sex and hypoglycemia.

Conclusions

Relative, but not absolute, glycemia during insulin treatment is independently associated with complications after an AMI. Future studies should investigate whether basing therapeutic glycaemic targets on relative glycemia improves patient outcomes.

     

Does the Type of Anesthetic Technique Affect In-Hospital and One-Year Outcomes after Off-Pump Coronary Arterial Bypass Surgery?

Despite numerous previous studies, there is little data on the effects of anesthetics on clinical outcome after off-pump coronary arterial bypass grafting (OPCAB). Therefore, we retrospectively compared the effects of anesthetic choice on in-hospital major adverse events (MAEs) and one-year major adverse cardiovascular and cerebral events (MACCEs) in patients undergoing OPCAB. Electronic medical records were reviewed in 192 patients who received propofol-remifenanil total intravenous anesthesia (TIVA) and propensity score-matched 662 patients who received isoflurane anesthesia. The primary endpoints were in-hospital MAEs and one-year MACCEs. The components of in-hospital MAEs were in-hospital death, myocardial infarction (MI), coronary revascularization, stroke, renal failure, prolonged mechanical ventilation longer than 72 h, and postoperative new cardiac arrhythmia requiring treatment. One-year MACCEs was defined as a composite of all-cause mortality, MI, coronary revascularization, and stroke. There was no significant difference in risk of in-hospital MAEs (OR = 1.29, 95% CI = 0.88–1.88, P = 0.20) or one-year MACCEs (OR = 0.81; 95% CI = 0.46–1.42, P = 0.46) between the groups. The risk of postoperative new arrhythmia including new atrial fibrillation significantly increased in the TIVA group compared to the isoflurane anesthesia group (OR = 1.72, 95% CI = 1.12–2.63, P = 0.01). In conclusion, the choice between propofol-remifentanil TIVA and isoflurane anesthesia did not show differences in incidence of in-hospital MAEs or one-year MACCEs in patients undergoing OPCAB. However, further studies on the effects of anesthetics on development of in-hospital new arrhythmia will be needed.