Incidence and Predictive Factors of Perioperative Cardiac Events in Patients Undergoing Noncardiac Major Vascular Surgery in Imam Reza University Hospital From December 2010 to December 2013

Document Type : Original Article

Authors

1 Department of Cardiology, Imam Reza University Hospital, Mashhad, IR Iran.

2 Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran.

3 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

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)
 

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References

  1. Fang JC, O'Gara PT. The history and physical examination and evidence-based approach. In: Libby P, Bonow RO, Mann DL, Zipes DP, Braundwald E, Achenbach S. Braunwald's heart disease a text book of cardiovascular medicine. 10th ed. Philadelphia: Saunders; 2015.ch 80.
  2. Jack L. Cronenwett, K. Wayne Johnston. Rutherford's Vascular Surgery, 7th ed.chapter30,31,32
  3. Sprung J1, Abdelmalak B, Gottlieb A, Mayhew C, Hammel J, Levy PJ, O'Hara P, Hertzer NR. Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery. Anesthesiology. 2000 Jul;93(1):129-40.
  4. Krupski WC1, Nehler MR, Whitehill TA. Preoperative cardiac risk management.Cardiovasc Surg. 2002 Aug; 10(4):415-20.
  5. Subramaniam B1, Panzica PJ, Novack V, Mahmood F, Matyal R, Mitchell JD, Sundar E, Bose R, Pomposelli F, Kersten JR, Talmor DS. Continuous perioperative insulin infusion decreases major cardiovascular events in patients undergoing vascular surgery: a prospective, randomized trial. Anesthesiology. 2009 May;110(5):970-7. doi: 10.1097/ALN.0b013e3181a1005b.
  6. de Liefde II1, Welten GM, Verhagen HJ, van Domburg RT, Stolker RJ, Poldermans D. Exercise blood pressure response and perioperative complications after major vascular surgery. Coron Artery Dis. 2011 Jun;22(4):228-32. doi: 10.1097/MCA.0b013e328345000e.
  7. Desai H1, Aronow WS, Ahn C, Gandhi K, Amin H, Lai HM, Tsai FS, Sharma M, Babu S. Incidence of perioperative myocardial infarction and of 2-year mortality in 577 elderly patients undergoing noncardiac vascular surgery treated with and without statins. Arch Gerontol Geriatr. 2010 Sep-Oct;51(2):149-51. doi: 10.1016/j.archger.2009.09.042. Epub 2009 Oct 12.
  8. Farkouh ME1, Rihal CS, Gersh BJ, Rooke TW, Hallett JW Jr, O'Fallon WM, Ballard DJ. Influence of coronary heart disease on morbidity and mortality after lower extremity revascularization surgery: a population-based study in Olmsted County, Minnesota (1970-1987). J Am Coll Cardiol. 1994 Nov 1;24(5):1290-6.
  9. Shrikhande GV1, Hamdan AD, Monahan TS, Pomposelli FB Jr, Scovell SD, Logerfo FW, Schermerhorn M. Low ejection fraction predicts shortened survival in patients undergoing infrainguinal arterial reconstruction. World J Surg. 2007 Dec;31(12):2422-6.
  10. Garcia S1, Moritz TE, Goldman S, Littooy F, Pierpont G, Larsen GC, Reda DJ, Ward HB, McFalls EO. Perioperative complications after vascular surgery are predicted by the revised cardiac risk index but are not reduced in high-risk subsets with preoperative revascularizationCirc Cardiovasc Qual Outcomes. 2009 Mar;2(2):73-7. doi: 10.1161/CIRCOUTCOMES.108.827683. Epub 2009 Mar 5.
  11. Asopa A1, Jidge S, Schermerhorn ML, Hess PE, Matyal R, Subramaniam B. Preoperative pulse pressure and major perioperative adverse cardiovascular outcomes after lower extremity vascular bypass surgery. Anesth Analg. 2012 Jun;114(6):1177-81. doi: 10.1213/ANE.0b013e3182290551. Epub 2011 Aug 4.
  12. McCann RL1, Clements FM. Silent myocardial ischemia in patients undergoing peripheral vascular surgery: incidence and association with perioperative cardiac morbidity and mortality. J Vasc Surg. 1989 Apr;9(4):583-7.
  13. Pasternack PF1, Grossi EA, Baumann FG, Riles TS, Lamparello PJ, Giangola G, Primis LK, Mintzer R, Imparato AM. The value of silent myocardial ischemia monitoring in the prediction of perioperative myocardial infarction in patients undergoing peripheral vascular surgery. J Vasc Surg. 1989 Dec;10(6):617-25.
  14. Ashton CM1, Petersen NJ, Wray NP, Kiefe CI, Dunn JK, Wu L, Thomas JM. The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery. Ann Intern Med. 1993 Apr 1;118(7):504-10.
  15. McFalls EO1, Ward HB, Santilli S, Scheftel M, Chesler E, Doliszny KM. The influence of perioperative myocardial infarction on long-term prognosis following elective vascular surgery. Chest. 1998 Mar;113(3):681-6

 

Iranian Heart Journal
Volume 21, Issue 4
October 2020
Pages 6-13

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