Risikofaktoren des postoperativen Myokardinfarktes

Abstract

Myocardial infarction after major surgery occurred 25 times in 214 patients who had previously sustained infarcts. Analysis of data obtained before, during and after 335 operations in these patients revealed the following pathogenetic factors in the infarction: (1) The patient with the highest coronary risk had arterial hypertension of at least 160/95 mmHg and advanced arteriosclerosis combined with coronary arterial, peripheral arterial, cerebrovascular, and renovascular disease. (2) Myocardial necrosis occurred when oxygen supply was reduced, as evidenced from a fall in systolic blood pressure to 70 mmHg or less during operation or anaemia (RBC smaller than or equal to 3,5 times 10-6/mul) early after operation. (3) Risk of infarction was highest during the early postoperative stress period with elevated plasma catecholamine levels and thus an increased myocardial oxygen demand.

Perioperative Myocardial Infarction

“…There is a positive correlation between hypertension and ischaemic heart disease [54], and Prys-Roberts, Meloche and Foex [78] reported that patients with untreated hypertension had the largest perioperative haemodynamic alterations which, again, has been reported to correlate with a high PMI rate (see below). It would therefore not be surprising if chronic hypertension also correlated with a high PMI rate, as reported by Eerola and colleagues [36], von Knorring [58], Steen, Tinker and Tarhan [94] and Vormittag and colleagues [99]. On the other hand, there was no significant correlation in the study by Rao, Jacobs and El-Etr [80] or that of Riles, Kopelman and Imparato [81] or in the multivariate analyses performed by Goldman and colleagues [40] and by Cooperman and colleagues [26].…”

“…Most authors have therefore included diabetes in their investigations of risk factors for PMI. To our knowledge, only Driscoll and colleagues [34] have suggested a possible connection (but without statistical analysis), and the statistical data seem to refute such a connection [40,58,70,94,99].…”

“…In one study the reinfarction rate was higher among men [96]; in another the mortality from PMI was greater among females [3]. Others have failed to find a sex-linked difference [40,58,80,94,99].…”

“…This is defined very differently: either as a given arterial pressure value on a preoperative evaluation [26,99] or as patients receiving antihypertensive medication [94]. There is a positive correlation between hypertension and ischaemic heart disease [54], and Prys-Roberts, Meloche and Foex [78] reported that patients with untreated hypertension had the largest perioperative haemodynamic alterations which, again, has been reported to correlate with a high PMI rate (see below).…”

Anästhesiologische Komplikationen bei Risikopatienten während und nach Ober- bzw. Unterbaucheingriffen

“…Hauptursache sind sicherlich die ~räo~erativen kardiovaskuiären Vorerkrankungen bei den' beobachteten Patientenkollektiven. Ursächlich mu13 dafür daher die verminderte Kompensationsbreite des kardiozirkulatorischen Systems in Kombination mit den verwandten Anästhetika angesehen werden (2,11,22,(35)(36)(37).…”