Discussion

Abstract

In the outline of the manuscript that I reviewed, there is an attempt to define outcomes as useful and consistent means with which uniform comparisons can be made across groups, databases, trials, and so forth. Specifically, the question of how to measure myocardial infarction was raised, and this obviously is a very complex question. We all struggle with it, inasmuch as we struggle with single-cell death versus patient death and the wide spectrum of changes that we see in between. I believe that in most practices, myocardial infarction is measured electrocardiographically, and I believe that we all have trepidation with respect to using enzymatic measures because we really do not know the exact thresholds that define myocardial infarction. What we lack, though, is consensus regarding how to measure injury; and this symposium, and the panel discussion that follows, is a step toward reaching such a consensus. As is evident from this symposium, there are many types of injury after bypass operations. There is the broad spectrum of degree of plaque stability with which patients present, and the potential for intraoperative ischemic and reperfusion injury, embolization, spasm, thrombosis, and death. Even for a common type of injury such as myocardial infarction, we all use a variety of definitions in our practices and specialties, lacking a consensus even among providers within a specialty.