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Article
The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery
Quantitative Health Sciences Publications and Presentations
  • Carol M. Ashton, University of Alabama
  • Nancy J. Petersen
  • Nelda P. Wray
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • J. Kay Dunn
  • Louis Wu
  • JoAnn M. Thomas
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
4-1-1993
Document Type
Article
Subjects
Adult; Aged; Cardiac Output, Low; Coronary Disease; Humans; Incidence; Intraoperative Complications; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Prospective Studies; Risk Factors; Vascular Diseases
Abstract

OBJECTIVES: 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.

DESIGN: Prospective cohort study.

SETTING: A large urban Veterans Affairs hospital.

PARTICIPANTS: A total of 1487 men older than 40 years undergoing major, nonemergent, noncardiac operations.

MEASUREMENTS: 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.

MAIN RESULTS: 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).

CONCLUSIONS: 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.

Rights and Permissions
Citation: Ann Intern Med. 1993 Apr 1;118(7):504-10.
PubMed ID
8442621
Related Resources
Link to Article in PubMed
Citation Information
Carol M. Ashton, Nancy J. Petersen, Nelda P. Wray, Catarina I. Kiefe, et al.. "The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery" Vol. 118 Iss. 7 (1993) ISSN: 0003-4819 (Linking)
Available at: http://works.bepress.com/catarina_kiefe/113/