Аннотация:Objective: To investigate the effect of volatile anesthetics on rate of postoperative myocardial infarction (MI) and cardiac death following coronary artery bypass graft (CABG).Design: Post-hoc analysis of a randomized trial.Setting: Cardiac surgery theaters.Participants: Patients undergoing elective, isolated CABG.4 Interventions: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane or sevoflurane) or total intravenous anesthesia (TIVA). Primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48h from surgery. Secondary outcome was 1-year death due to cardiac causes. Measurements and Main Results: 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). Mean age was 62±8.4 years, and median baseline ejection fraction was 57 (50-67)%, without differences between the two groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14/2,530 [0.6%] versus 27/2,501 [1.1%] in the TIVA group; p=0.038) and as-treated analyses (16/2,708 [0.6%] versus 29/2,617 [1.1%] in the TIVA group; p=0.039), but not in the intention-to-treat analysis (17/2,663 (0.6%) versus 28/2,667 (1.0%) in the TIVA group; p=0.10). Overall, death due to cardiac causes was lower in the volatile group (23/2,685 [0.9%] versus 40/2,668 [1.5%] 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.Study registration: ClinicalTrials.gov, NCT02105610, Registered 7 April 2014, https://clinicaltrials.gov/ct2/show/NCT02105610.KEY WORDScardioprotection; mortality; myocardial infarction; cancer; cardiac anesthesia; cardiac surgery; sevoflurane; desflurane