Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery

Article Abstract:

Major surgery is extremely stressful, and heart complications following surgery are a major cause of postoperative death and illness. In the US, about 25 million noncardiac surgical operations are performed each year; 50,000 of those patients will have a heart attack after surgery and more than 20,000 of the 40,000 postoperative deaths will be due to cardiac events. Previous studies have shown that patients with heart problems prior to the operation are at especially high risk. Researchers have now investigated if the close monitoring of patients after surgery can help predict which patients are at the highest risk for adverse cardiac events such as ischemia or heart attack. A total of 474 men who either had known cardiovascular disease or who were at high risk for it were prospectively studied in the period following elective noncardiac surgery. A total of 83 patients (18 percent) suffered adverse cardiac events in the perioperative period; 15 had ischemic events including heart attack, 30 had congestive heart failure without ischemia, and 38 had ventricular tachycardia (irregular rapid contraction of the ventricles). About half of the observed events occurred after the third postoperative day. Five patients died of heart attacks and one died of left ventricular failure. Myocardial ischemia, which occurred in 40 percent of the postsurgical patients, was strongly associated with an adverse outcome. Patients with myocardial ischemia had a roughly threefold increased risk of an adverse cardiac outcome, and a ninefold increase in the odds of having a heart attack, unstable angina, or cardiac death. In almost all the patients, the ischemia was without symptoms (silent). Previous research has found that from 50 to 70 percent of ischemic attacks in postoperative patients are silent, while less than 40 percent are silent in nonsurgical patients. This fact, which may be due to residual effects of anesthetics and the use of pain-killers in the postoperative period, suggests that close monitoring of heart function is necessary in postoperative patients. However, further research will be necessary to determine if intervention based on closer monitoring will be effective in the reduction of postoperative morbidity and mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Heart attack, Heart failure

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Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery

Article Abstract:

Five factors can predict which patients are in danger of postoperative myocardial ischemia. Myocardial ischemia occurs when the blood supply to the heart is reduced. A study of 474 male patients who were undergoing surgery showed the likelihood of myocardial ischemia increased with the number of risk factors. All the men had coronary heart disease or were at high risk of the disease. The most important factors were left ventricular hypertrophy (LVH) - an enlarged heart - and previous history of myocardial ischemia. Others were high blood pressure, diabetes, coronary artery disease (CAD) and use of digoxin. Previous coronary artery bypass surgery and similar procedures reduced the risk for patients with CAD. There was no advantage to resuming medication for coronary artery disease within 24 hours or within 48 hours. Over seven million patients undergoing surgery other than heart surgery are at risk. They include both patients who have or who are at risk for CAD and 4 million patients over age 65.

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Monitoring for myocardial ischemia during noncardiac surgery: a technology assessment of transesophageal echocardiography and 12-lead electrocardiography

Article Abstract:

Routine monitoring for postoperative myocardial ischemia using transesophageal echocardiography (TEE) or 12-lead electrocardiography (12-lead-ECG) is not better than two-lead ECG to identify patients at high risk. Myocardial ischemia occurs when the blood supply to the heart is reduced. Of 285 men undergoing surgery who were monitored by all three techniques, 111 were found to have myocardial ischemia during surgery. Monitoring with two-lead ECG identified more patients with postoperative myocardial ischemia (26%) than did either TEE (15%) or 12-lead ECG (14%). Anesthesiologists identified only 2% of these patients. Both TEE and 12-lead ECG may help identify more patients with myocardial ischemia but do not identify more patients at risk.

Methods, Evaluation, Diagnosis, Electrocardiography, Echocardiography

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