Document Type: Original Article
Department of Cardiology, Imam Reza University Hospital, Mashhad, IR Iran.
Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Background: Cardiovascular morbidity and mortality represent a special concern in a patient with known or unknown cardiovascular disease undergoing high-risk noncardiac surgeries such as major vascular surgery.
Methods: Over a period of 36 months, from 2010 to 2013, we enrolled 65 patients in the Vascular Surgery Department of Imam Reza University Hospital. To assess the patients before major vascular surgery, we performed electrocardiography and echocardiography; and depending on these modality findings, some of the patients were candidated for the exercise test, thallium scan, and coronary angiography. During surgery, the patients had cardiac monitoring; and after surgery, they underwent cardiac monitoring, echocardiography, and cardiac troponin tests.
Results: In the entire study population, the prevalence rate of perioperative ischemia was 18.5%, myocardial infarctions 4.6%, and arrhythmias 6.4% and hypotension 9.2% in the operating room. The prevalence of death owing to cardiac events during surgery was 4.6% in the whole study population. Additionally, 27.7% of the patients had no perioperative cardiac events. In the comparison of the risk factors, hypertension (72.2% vs 57.4; P = 0.021), diabetes (50% vs 19.1%; P = 0.017), smoking (62% vs 40%; P = 0.05), and previous ischemic heart diseases (58.5% vs 31.5%; P = 0.042) were more common in the patients with cardiac events.
Conclusions:Perioperative cardiac assessments and cardiac risk factor modifications may be considered in major vascular surgery. Close cardiac monitoring during and after surgery plays a significant role in decreasing cardiac events. (Iranian Heart Journal 2020; 21(4): 6-13)