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MYRIAD: Anesthesia methods lead to similar outcomes in CABG

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Among patients undergoing elective CABG, there was no difference in 1-year mortality between those assigned IV anesthesia and those assigned a volatile anesthetic, according to the results of the MYRIAD trial.

The researchers randomly assigned 5,400 patients (mean age, 62 years; 19% women) undergoing isolated elective CABG at 36 centers in 13 countries to total IV anesthesia or an intraoperative regimen including a volatile anesthetic such as desflurane, isoflurane or sevoflurane. The results were presented at the International Symposium on Intensive Care and Emergency Medicine and published in The New England Journal of Medicine.

On-pump CABG was performed in 64% of patients and mean duration of cardiopulmonary bypass was 79 minutes.

The trial was stopped for futility after an interim analysis, Giovanni Landoni, MD, head of the research, anesthesia and intensive care department, IRCCS San Raffaele Scientific Institute, Milan, and colleagues reported.

The primary outcome of 1-year mortality did not differ between the groups (volatile group, 2.8%; IV group, 3%; RR = 0.94; 95% CI, 0.69-1.29), nor did mortality differ at 30 days (volatile group, 1.4%; IV group, 1.3%; RR = 1.11; 95% CI, 0.7-1.76), according to the researchers.

The groups also did not differ in any of the secondary outcomes, including cardiac death at 30 days or 1 year, nonfatal MI or death at 30 days, readmissions, duration of ICU stay and length of hospital stay.

“Our trial focused on patients who underwent isolated elective CABG. Thus, we cannot comment on whether volatile anesthetics would have a different effect on patients undergoing complex surgery,” Landoni and colleagues wrote in NEJM. “However, previous trials and meta-analyses showed no benefit in other types of cardiac surgery or in combined procedures.” – by Erik Swain

References:

Landoni G, et al. Optimizing perioperative care. Presented at: International Symposium on Intensive Care and Emergency Medicine; March 19-22, 2019; Brussels.

Landoni G, et al. N Engl J Med. 2019;doi:10.1056/NEJMoa1816476.

Disclosure s : Landoni reports he received personal fees from AbbVie and Baxter. Please see the study for all other authors’ relevant financial disclosures.