Incidence of Myocardial Infarction After High-Risk Vascular Operations in Adults

Juo, Yen-Yi; Mantha, Aditya; Ebrahimi, Ramin; Ziaeian, Boback; Benharash, Peyman

doi:10.1001/jamasurg.2017.3360

Cited by 28 publications

(23 citation statements)

References 68 publications

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“…Perioperative myocardial ischemia in non-cardiac surgery occurs mostly as consequence of endogenous catecholamine release and acute inflammatory response, resulting in an increased oxygen demand, heart rate, and contractility. Inflammation also leads to changes in atheromatous plaque features, culminating in the rupture of lipid-laden vulnerable lesions, thrombocytes activation with development of platelet-rich thrombi, acute vessel occlusion, and ischemia [ 47 , 48 ]. Perioperative statins might reduce the risk of perioperative infarction due to its properties of endothelial modulation resulting in vasodilation in addition to its anti-inflammatory effects, reducing plaque instability [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Putzu

Silva

Almeida

et al. 2018

Ann. Intensive Care

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BackgroundThe effects of perioperative statin therapy on clinical outcome after cardiac or non-cardiac surgery are controversial. We aimed to assess the association between perioperative statin therapy and postoperative outcome.MethodsElectronic databases were searched up to May 1, 2018, for randomized controlled trials of perioperative statin therapy versus placebo or no treatment in adult cardiac or non-cardiac surgery. Postoperative outcomes were: myocardial infarction, stroke, acute kidney injury (AKI), and mortality. We calculated risk ratio (RR) or odds ratio (OR) and 95% confidence interval (CI) using fixed-effects meta-analyses. We performed meta-regression and subgroup analyses to assess the possible influence of statin therapy regimen on clinical outcomes and trial sequential analysis to evaluate the risk of random errors and futility.ResultsWe included data from 35 RCTs involving 8200 patients. Perioperative statin therapy was associated with lower incidence of postoperative myocardial infarction in non-cardiac surgery (OR = 0.44 [95% CI 0.30–0.64], p < 0.0001), but not in cardiac surgery (OR = 0.93 [95% CI 0.70–1.24], p = 0.61) (psubgroup = 0.002). Higher incidence of AKI was present in cardiac surgery patients receiving perioperative statins (RR = 1.15 [95% CI 1.00–1.31], p = 0.05), nonetheless not in non-cardiac surgery (RR = 1.52 [95% CI 0.71–3.26], p = 0.28) (psubgroup = 0.47). No difference in postoperative stroke and mortality was present in either cardiac or non-cardiac surgery. However, low risk of bias trials performed in cardiac surgery showed a higher mortality with statins versus placebo (OR = 3.71 [95% CI 1.03–13.34], p = 0.04). Subgroup and meta-regression analyses failed to find possible relationships between length of statin regimens and clinical outcomes. Trial sequential analysis suggested no firm conclusions on the topic.ConclusionsPerioperative statins appear to be protective against postoperative myocardial infarction in non-cardiac surgery and associated with higher AKI in cardiac surgery. Possible positive or even negative effects on mortality could not be excluded and merits further investigations. Currently, no randomized evidence supports the systematic administration of statins in surgical patients.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0441-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Putzu

Silva

Almeida

et al. 2018

Ann. Intensive Care

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“…Studies that focused on postoperative myocardial infarction in patients undergoing abdominal aortic surgeries have reported an incidence of 3.1% to 5.2%, which is similar to the incidence of PMI in our study of 3.5%. [ 15 16 17 ]…”

Section: Discussionmentioning

confidence: 99%

Perioperative Cardiovascular Outcome in Patients with Coronary Artery Disease Undergoing Major Vascular Surgery

Thomas

Sharmila

Babu

et al. 2022

Annals of Cardiac Anaesthesia

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Background: Major adverse cardiac events (MACE) are a major contributor to morbidity and mortality in patients undergoing major vascular surgeries. We aim to assess the incidence, risk factors, and outcome of MACE in patients with coronary artery disease (CAD) undergoing aortic surgeries. Methods: In this retrospective observational study, we included patients with CAD who underwent elective major vascular surgery, namely, thoracoabdominal aortic aneurysm repairs and vascular bypass surgeries for aorto-occlusive disease, in our institute from January 2010 to December 2019. The association of preoperative risk factors including revised cardiac risk index factors, functional status of patients, severity of CAD, and its treatment status and technique of anesthesia with occurrence of MACE was analyzed. Results: Medical records of 141 patients were studied. The incidence of perioperative MACE was 11.3% (16/141) and overall in-hospital mortality was 6.4% (9/141), all of them related to MACE; implicating a 56.2% mortality in patients who develop MACE. The odds of a patient who had undergone preoperative coronary revascularization to develop a MACE was higher than a nonrevascularized patient (odds ratio: 3.9; 95% confidence interval [CI], 1.34–11.34). There was found to be no benefit in the addition of epidural analgesia to general anesthesia in reducing perioperative MACE. Conclusions: Major vascular surgeries in patients with CAD are a highly morbid procedure and a perioperative MACE places them at a significantly high risk of mortality. Early detection of CAD and preoperative medical optimization can play a major role in reducing the risk of MACE.

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“…36 This makes the NSQIP MICA prone to underestimation of risk for postoperative MI, especially in high-incidence scenarios. 13,37 The RCRI was developed almost two decades ago and based on serial CK/CK-MB measurements with regard to the biomarker criterion of MI. 8 This external validation study used high-sensitivity troponins, which are able to detect twice as many MIs as with non-high-sensitivity assays.…”

Section: Discussionmentioning

confidence: 99%

External validation of the Revised Cardiac Risk Index and National Surgical Quality Improvement Program Myocardial Infarction and Cardiac Arrest calculator in noncardiac vascular surgery

Fronczek

Polok

Devereaux

et al. 2019

British Journal of Anaesthesia

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Background: The National Surgical Quality Improvement Program Myocardial Infarction & Cardiac Arrest (NSQIP MICA) calculator and the Revised Cardiac Risk Index (RCRI) were derived using currently outdated methods of diagnosing perioperative myocardial infarctions. We tested the external validity of these tools in a setting of a systematic perioperative cardiac biomarker measurement. Methods: Analysis of routinely collected data nested in the Vascular Events In Noncardiac Surgery Patients Cohort Evaluation Study. A consecutive sample of patients !45 yr old undergoing in-hospital noncardiac surgery in a single tertiary care centre was enrolled. The predictive performance of the models was tested in terms of the occurrence of major cardiac complications defined as a composite of a nonfatal myocardial infarction, a nonfatal cardiac arrest, or a cardiac death within 30 days after surgery. The plasma concentration of high-sensitivity troponin T was measured before surgery, 6e12 h after operation, and on the first, second, and third days after surgery. Myocardial infarction was diagnosed according to the Third Universal Definition. Results: The median age was 65 (59e72) yr, and 704/870 (80.9%) subjects were male. The primary outcome occurred in 76/ 870 (8.7%; 95% confidence interval [CI], 6.9e10.8%) patients. The c-statistic was 0.64 (95% CI, 0.57e0.70) for the NSQIP MICA and 0.60 (95% CI, 0.54e0.65) for the RCRI. Predicted risks were systematically underestimated in calibration belts (P<0.001). The RCRI and the NSQIP MICA showed no clinical utility before recalibration. Conclusions: The NSQIP and RCRI models had limited predictive performance in this at-risk population. The recently updated version of the RCRI was more reliable than the original index.

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Incidence of Myocardial Infarction After High-Risk Vascular Operations in Adults

Abstract: The incidence of MI did not significantly decrease in the past decade and has been consistently associated with worse clinical outcomes. Further inquiry into why advanced perioperative care did not reduce cardiac complications is important to quality improvement efforts.

Cited by 28 publications

References 68 publications

Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials

Perioperative Cardiovascular Outcome in Patients with Coronary Artery Disease Undergoing Major Vascular Surgery

External validation of the Revised Cardiac Risk Index and National Surgical Quality Improvement Program Myocardial Infarction and Cardiac Arrest calculator in noncardiac vascular surgery

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