Detection and Significance of Intraoperative and Postoperative Myocardial Ischemic in Peripheral Vascular Surgery

Raby, Khether E.

doi:10.1001/jama.1992.03490020070033

Cited by 193 publications

(31 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Evidence suggests that postoperative myocardial infarction (MI) negatively impacts both short- and long-term survival. 4,6–9 In a recent series, utilizing Vascular Study Group of New England (VSGNE) data, postoperative MI was correlated with worse survival following carotid revascularization. 10 Troponin elevations have also been shown to correlate with negative outcomes for a wide range of diagnoses, from acute coronary syndromes, 11,12 to critically ill medical patients, 13 to all types of noncardiac surgical procedures, 14 and to vascular surgical procedures in particular.…”

mentioning

confidence: 99%

The effect of postoperative myocardial ischemia on long-term survival after vascular surgery

Simons

Baril

Goodney

et al. 2013

Journal of Vascular Surgery

View full text Add to dashboard Cite

Introduction The impact of a postoperative troponin elevation on long-term survival after vascular surgery is not well-defined. We hypothesize that a postoperative troponin elevation is associated with significantly reduced long-term survival. Methods The Vascular Study Group of New England registry identified all patients who underwent carotid revascularization, open abdominal aortic aneurysm repair (AAA), endovascular AAA repair, or infrainguinal lower extremity bypass (2003–2011). The association of postoperative troponin elevation and myocardial infarction (MI) with 5-year survival was evaluated. Multivariable models identified predictors of survival and of postoperative myocardial ischemia. Results In the entire cohort (n = 16,363), the incidence of postoperative troponin elevation was 1.3% (n = 211) and for MI was 1.6% (n = 264). Incidences differed across procedures (P < .0001) with the highest incidences after open AAA: troponin elevation, 3.9% (n = 74); MI, 5.1% (n = 96). On Kaplan-Meier analysis, any postoperative myocardial ischemia predicted reduced survival over 5 years postoperatively: no ischemia, 73% (standard error [SE], 0.5%); troponin elevation, 54% (SE, 4%); MI, 33% (SE, 4%) (P < .0001). This pattern was observed for each procedure subgroup analysis (P < .0001). Troponin elevation (hazard ratio, 1.45; 95% confidence interval, 1.1–2.0; P = .02) and MI (hazard ratio, 2.9; 95% confidence interval, 2.3–3.8; P < .0001) were independent predictors of reduced survival at 5 years. Conclusions Postoperative troponin elevation and MI predict a 26% or a 55% relatively lower survival in the 5 years following a vascular surgical procedure, respectively, compared with patients who do not experience myocardial ischemia. This highlights the need to better characterize factors leading to postoperative myocardial ischemia. Postoperative troponin elevation, either alone, or in combination with an MI, may be a useful marker for identifying high-risk patients who might benefit from more aggressive optimization in hopes of reducing adverse long-term outcomes.

show abstract

mentioning

confidence: 99%

The effect of postoperative myocardial ischemia on long-term survival after vascular surgery

Simons

Baril

Goodney

et al. 2013

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…Also, the incidence of postoperative myocardial ischemia has been shown to increase with increasing admission SBP [94]. This may be of concern since the association between postoperative myocardial ischemia and postoperative ischemic cardiac events has been shown to be significant [130-132]. Induction of anesthesia in elderly patients with uncontrolled SBP showed substantial decrease of systolic pressure and stroke volume with marked vasopressor response to noxious stimuli [124].…”

Section: Isolated Systolic Hypertension As a Perioperative Cardiovascmentioning

confidence: 99%

Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor?

Fayad¹,

Yang

2008

CCR

View full text Add to dashboard Cite

We are presenting a review of Isolated Systolic Hypertension (ISH) as a cardiovascular risk factor with emphasis on the perioperative period.Isolated systolic hypertension is associated with aging and is the most frequent subtype (65%) among patients with uncontrolled hypertension. ISH is strongly associated with increased risks of cardiac and cerebrovascular events exceeding those in comparably aged individuals with diastolic hypertension. Patients with ISH show an increase in left ventricular (LV) mass and an increase in the prevalence of left ventricular hypertrophy (LVH). These LV changes increase cardiovascular events and frequently lead to diastolic dysfunction (DD). Treatment to reduce elevated systolic blood pressure has been shown to reduce the risk of cardiovascular events.In the perioperative setting, essential hypertension has not been found to be a significant risk factor for cardiac complications. Most of the studies were based on the definition of essential hypertension and underpowered in sample size. The significance of perioperative ISH, however, is not well studied, partly due to its recognition only fairly recently as a cardiovascular risk factor in the non-surgical setting, and partly due to the evolving definition of ISH.Perioperative cardiac complications remain a significant problem to the healthcare system and to the patient. Although the incidence of perioperative cardiac complications is prominent in high-risk patients as defined by the Revised Cardiac Risk Index (RCRI), the bulk of the cardiac complications actually occur in low-risk group. Currently, little understanding exists on the occurrence of perioperative cardiac complications in low- risk patients. A factor such as ISH, with its known pathophysiological changes, is a potential perioperative risk factor.We believe ISH is an under-recognized perioperative risk factor and deserves further studying. Our research group has recently been funded by the Heart Stroke Foundation (HSF) to examine ISH as a perioperative risk factor (PROMISE Study).

show abstract

“…Porém estes estudos foram limitados pelo fato de a maioria dos pacientes apresentarem hipertensão nos estágios 1 e 2, sendo poucos os casos de hipertensão no estágio 3. Alguns trabalhos encontraram relação entre o nível da pressão arterial, e, portanto, a gravidade da hipertensão, com a ocorrência de isquemia miocárdica intra e pós-operatória [33][34][35][36] . Outro estudo realizado com cerca de 7.000 cirurgias vasculares falhou em demonstrar a HAS como fator de risco para infarto do miocárdio peri-operatório 37 , talvez por ser esta uma comorbidade muito freqüente em cirurgias vasculares.…”

Section: Incidência E Classificação Da Hasunclassified

“…These studies, however, were limited by the fact that most patients presented hypertension stage 1 and 2, with few cases of stage 3. Some studies have found relationship between blood pressure level, thus hypertension severity, and intra and postoperative myocardial ischemia [33][34][35][36] . Another study with approximately 7 thousand vascular surgeries has failed to show SH as risk factor for perioperative myocardial infarction 37 , possibly because this is a very frequent co-morbidity during vascular procedures.…”

Section: Hypertension and Anesthesiamentioning

confidence: 99%

Hipertensão arterial sistêmica e anestesia

Lorentz

Santos

2005

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

show abstract

Detection and Significance of Intraoperative and Postoperative Myocardial Ischemic in Peripheral Vascular Surgery

Abstract: Preoperative ischemia appears to identify high-risk patients, and subsequent perioperative monitoring detects silent ischemia that commonly precedes clinical events and that may be treatable with anti-ischemia therapy.

Cited by 193 publications

References 22 publications

The effect of postoperative myocardial ischemia on long-term survival after vascular surgery

The effect of postoperative myocardial ischemia on long-term survival after vascular surgery

Is Peri-Operative Isolated Systolic Hypertension (ISH) a Cardiac Risk Factor?

Hipertensão arterial sistêmica e anestesia

Contact Info

Product

Resources

About