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The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery.
- Source :
-
Annals of Internal Medicine . 4/1/93, Vol. 118 Issue 7, p504-510. 7p. - Publication Year :
- 1993
-
Abstract
- <bold>Objectives: </bold>To determine the incidence of and risk factors for perioperative myocardial infarction with noncardiac surgery and to test the accuracy of a risk stratification system.<bold>Design: </bold>Prospective cohort study.<bold>Setting: </bold>A large urban Veterans Affairs hospital.<bold>Participants: </bold>A total of 1487 men older than 40 years undergoing major, nonemergent, noncardiac operations.<bold>Measurements: </bold>Infarction was established by at least two of the following: development of new Q waves, typical change in creatine kinase MB, and positive technetium pyrophosphate scintigraphy. Patients were stratified preoperatively into high-, intermediate-, low-, and negligible-risk strata based on clinical markers corresponding to different levels of coronary artery disease prevalence.<bold>Main Results: </bold>Patients with coronary disease (high-risk stratum) had a 4.1% incidence of infarction (13 of 319; 95% CI, 1.8% to 6.4%); patients with peripheral vascular disease but no evidence of coronary disease (intermediate-risk stratum) had a 0.8% incidence (2 of 260, upper bound of CI, 2.0%); patients with high atherogenic risk factor profiles but no clinical atherosclerosis (low-risk stratum) had a 0% incidence (0 of 256, upper bound of CI, 1.2%). No cardiac deaths occurred in 652 men who had no atherosclerosis and low atherogenic risk factor profiles (the negligible-risk stratum). Factors independently associated with infarction included age more than 75 years (adjusted odds ratio, 4.77; CI, 1.17 to 19.41), signs of heart failure on the preoperative examination (adjusted odds ratio, 3.31; CI, 0.96 to 11.38), coronary disease (adjusted odds ratio, 10.39; CI, 2.27 to 47.46), and a planned vascular operation (adjusted odds ratio, 3.72; CI, 1.12 to 12.37).<bold>Conclusions: </bold>Coronary artery disease is the major risk factor for perioperative infarction. The stratification scheme identifies subsets of patients with different risks, and finer within-stratum distinctions can be made using additional variables. [ABSTRACT FROM AUTHOR]
- Subjects :
- *MYOCARDIAL infarction
*SURGERY
Subjects
Details
- Language :
- English
- ISSN :
- 00034819
- Volume :
- 118
- Issue :
- 7
- Database :
- Academic Search Index
- Journal :
- Annals of Internal Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 6984025
- Full Text :
- https://doi.org/10.7326/0003-4819-118-7-199304010-00004