Perioperative myocardial ischemia and isolated systolic hypertension in non-cardiac surgery

Abstract

Perioperative myocardial ischemia and isolated systolic hypertension in non-cardiac surgery L'ischémie myocardique périopératoire et l'hypertension systolique isolée en chirurgie non cardiaque Ashraf A. Fayad Results A total of 312 (150 ISH and 162 normotensive) patients completed the study. Orthopedic surgery was the most frequent surgical procedure in both groups. The overall incidence of PMI was 19.7% in the ISH group compared with 18.8% in the normotensive group (difference 0.9%; 95% confidence interval [CI], -7.9% to 9.8%). The overall incidence of adverse events was 4.0% in the ISH group compared with 1.9% in the normotensive group (difference 2.2%; 95% CI, -1.6% to 5.9%). Conclusion In this study, we chose to examine ISH as potential cardiac risk factor for patients undergoing noncardiac surgery. The incidence of myocardial ischemia, a surrogate outcome, was similar in the two groups. The relatively high incidence of myocardial ischemia (19.2%) was of particular interest in this relatively low cardiac risk surgical population. (ClinicalTrials.gov number, NCT01237652). RésuméObjectif L'objectif de cette e´tude e´tait de de´terminer si les patients atteints d'hypertension systolique isole´e (HSI) pre´sentaient une incidence plus e´leve´e d'ische´mie myocardique pe´riope´ratoire et donc un risque plus e´leved 'e´ve´nements de´favorables pe´riope´ratoires que les patients normotendus subissant une chirurgie non cardiaque. Méthode Apre`s avoir obtenu l'approbation du Comited 'e´thique de la recherche, des patients ont e´te´recrute´s et attribue´s soit à un groupe HSI (tension arte´rielle systolique (TAS) [ 140 avec tension arte´rielle diastolique (TAD) \ 90 mmHg) ou a`un groupe normotendu (TAS \ 140 et TAD \ 90 mmHg), selon leur tension arte´rielle pre´ope´ratoire au repos. Le crite`re de jugement principal e´tait l'incidence globale d'ische´mie myocardique pe´riope´ratoire (IMP) telle que de´termine´e par monitorage de Holter ambulatoire

Obesity & hypertension are determinants of poor hemodynamic control during total joint arthroplasty: a retrospective review

“…There is evidence in the orthopaedic literature that poor intra-operative blood pressure control is associated with increased risk for complication after TJA. One prior study found that systolic blood pressures above 150.6±9 mmHg significantly increased the risk of myocardial infarction in a cohort of patients undergoing a variety of non-cardiac procedures (orthopedic procedures represented greater than 50% of procedures in this study) [18]. Another study found that an intraoperative arrhythmia or other alteration in heart rate during TJA increased the risk of perioperative stroke [9].…”

“…As such we do not report a complication rate. The literature suggests that poor hemodynamic control during surgery leads to adverse outcome; [1,7-9,11,18,29] however, without postoperative outcome data it is unclear whether this assumption holds true in our population. Another potential limitation of this study pertains to the preoperative measurement of hypertension.…”

“…Despite evidence that pre-existing hypertension affects intra-operative blood pressure control there is no consensus on the impact of hypertension on perioperative outcome [29]. Some studies have suggested that perioperative hypertension has minimal impact on outcome while other studies have found that perioperative hypertension increases the risk for cardiac complication [18]. As such there is no consensus on management of the hypertensive patient prior to non-cardiac surgery [30].…”

Postanesthesia Care for the Elderly Patient

“…14 A study in the Canadian Journal of Anesthesia found that those with isolated systolic hypertension exhibited no increased risk of perioperative myocardial ischemia compared with a normotensive control group. 15 Although the trend is to maintain blood pressure at usual values for patients with hypertension and for those without hypertension, antihypertensive medications should be continued in the perioperative period, especially β-blockade. 16 β-blockade for patients with known cardiac risk factors has become a quality metric for most hospitals despite some controversy over the risks of stroke.…”

Effect of remote ischaemic preconditioning in patients with ischaemic heart disease undergoing orthopaedic surgery: a randomized controlled trial

“…Patients undergoing major orthopaedic surgery with previous ischaemic heart disease are at risk of perioperative myocardial ischaemia. 9 The risk of ischaemia of major organs, including the heart, can be increased because of intraoperative bleeding and hypotension during orthopaedic surgery and discontinued antiplatelet agents. However, there is no effective measure to mitigate the perioperative ischaemiaereperfusion injury of major organs in these patients.…”