Are the Incidences of Cardiac Events During Noncardiac Surgery in Japan the Same as in the United States and Europe?

Abstract

In Japan, an ever-present problem in the preoperative evaluation of patients with ischemic heart disease is that although such evaluations are based on Western data, these data serve as the basis for determining perioperative risk in Japanese patients. To remedy this problem, the Cardiac Ischemia and Anesthesia Research Committee was formed in 1997 and has conducted studies of perioperative complications in noncardiac surgery in Japan. In two retrospective studies in 1997, the proportions of patients with ischemic heart disease were 3.9% and 3.1%, approximately one tenth the rates reported in Europe and the United States. The incidences of perioperative cardiac complications in patients with ischemic heart disease were 16.4% and 13.2%, not widely divergent from rates reported in Europe and the United States. To investigate the baseline characteristics involved in perioperative complications, we conducted a prospective study of 237 patients classified as having intermediate risk for perioperative cardiac complications according to the American College of Cardiology/American Heart Association Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery. We found that the prominent factor in intraoperative cardiac complications was the presence of hypertension (odds ratio = 2.911). Factors contributing to postoperative cardiac complications included those reflecting coronary lesion severity and cardiac dysfunction (history of heart failure; odds ratio = 6.884, coronary risk index grade; odds ratio = 2.884, and a history of intervention; odds ratio = 4.774).

Nicorandil decreases cardiac events during and after noncardiac surgery

“…Eighty-four patients received nicorandil during surgery and 237 patients received standard care [8]. Table 1 shows the patients' characteristics and the number of patients with preoperative diagnoses or symptoms.…”

“…Anesthesiologists in each hospital monitored cardiac events during the operation and the following 5 days. The frequency of cardiac events in the nicorandil-treated patients was compared with those in nonadministered patients at the same risk level, who had the same risk surgical procedures and whose probability of experiencing cardiac events was analyzed previously [8].…”

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

“…Scattered reports also continued to suggest that hypertension might be one of the risk factors for perioperative cardiovascular morbidity and mortality. [15][16][17] A recent study of patients undergoing coronary artery bypass grafting (CABG) found that ISH was an independent cardiac risk factor and was associated with a 40% increase in the likelihood of perioperative cardiovascular morbidity. 18 Clinically important differences in comorbidities and surgical considerations between cardiac and non-cardiac surgery suggests the need for a similar study in non-cardiac surgery to investigate the incidence of perioperative myocardial ischemia in ISH.…”

Hipertensão arterial sistêmica e anestesia

“…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.…”

“…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.…”