Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Department of General Anesthesiology, The Cleveland Clinical Foundation, Cleveland, Ohio
Anesthesiology, 93: 129–140, 2000
Patients undergoing vascular surgical procedures are at high risk for perioperative myocardial infarction (PMI). Using the Vascular Surgery Registry, covering 6,948 operations from January 1989 through June 1997, the authors identified 107 patients in whom PMI developed during the same hospital stay. Case-control patients (i.e., those without PMI) were matched at a 1x:x1 ratio with index cases, based on the type of surgery, gender, patient age, and year of surgery. The data were analyzed in terms of preoperative cardiac disease and surgical and anesthetic factors to study their association with PMI and cardiac death. Using multivariate analysis, the authors identified the following predictors of PMI: valvular disease; previous congestive heart failure; general anesthesia; preoperative history of coronary artery disease; preoperative treatment with β-blockers; lower preoperative and postoperative hemoglobin concentrations; increased bleeding rate, as assessed from increased cell salvage; and lower ejection fraction. Of the 107 patients with PMI, 20.6% died of a cardiac cause during the same hospital stay. The odds ratios for cardiac death were increased by the following factors: recent congestive heart failure, type of surgery, emergency surgery, lower intraoperative diastolic blood pressure, new intraoperative ST-T changes, and increased intraoperative use of blood. Patients who underwent coronary artery bypass grafting, even more than 12 mo before index surgery, had a 79% reduction in the risk of death if they had PMI. Multivariate analysis showed that a preoperative definitive diagnosis of coronary artery disease and significant valvular disease were associated with an increased risk of PMI. Congestive heart failure less than 1 yr before index vascular surgery and greater intraoperative use of blood were associated with cardiac death. A history of coronary artery bypass grafting lessened the risk of cardiac death in patients with PMI. The in-hospital mortality rate is high for patients who undergo vascular surgery and experience clinically significant PMI. The stress of surgery (increased intraoperative bleeding and aortic, peripheral vascular, and emergency surgery), poor preoperative cardiac functional status (congestive heart failure, lower ejection fraction, diagnosis of coronary artery disease) and a preoperative history of coronary artery bypass grafting are factors that determine perioperative cardiac morbidity and mortality rates.
