Intraoperative Risk Factors of Myocardial Infarction in Non-Cardiac Surgeries

Котвицкая, З. Т.; Колотова, Г. Б.; Руднов, В. А.; Багин, В А

doi:10.21292/2078-5658-2018-15-2-32-37

Cited by 12 publications

(5 citation statements)

References 8 publications

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“…Различные И КР в настоящее время являются общепризнанным инструментом оценки риска периоперационных кардиальных осложнений. Н аи более часто рекомендуют использование простого ИКР Lee и более современного ИКР MICA [6,11,14,27]. Именно эти ИКР включены в большинство современных рекомендаций по риск-снижающей стратегии в некардиальной хирургии.…”

Section: Discussionunclassified

Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

Соколов

Lyuboshevsky

Староверов

et al. 2021

Vestn. anesteziol. reanimatol.

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The objective: to analyze the incidence and spectrum of cardiovascular complications within 12 months after noncardiac surgery, as well as to assess the association of preoperative values of various cardiac risk indices (CRI) and other potential risk factors with the actual development of complications.Subjects and Methods. We analyzed data of medical records and telephone interviews of 141 patients aged 65 [60-71] years who had undergone non-cardiac surgery a year before the interview The operations were low risk in 13.5% of observations, medium risk in 64.5%, and high risk in 22%. A retrospective calculation of the Revised CRI (RCRI), Individual CRI (Khoronenko CRI), and the American College of Surgeons Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) was performed.Results. Cardiac events (myocardial infarction, decompensation of chronic heart failure, new arrhythmias, stroke, and/or the need to prescribe or escalate the dose of cardiovascular drugs and/or hospitalization for cardiac indications, and/or death from cardiovascular diseases) within 12 months after elective noncardiac surgeries were detected in 27.7% of cases, and in 2.1% of patient's death occurred due to cardiac disorders. Predictors of cardiac events were concomitant ischemic heart disease (OR = 2.777; 95% CI 1.286-5.966; p = 0.0093) and chronic heart failure (OR = 2.900; 95% CI 1.224-6.869; p = 0, 0155), RCRI (OR = 1.886; 95% CI 1.2-8-2.944; p = 0.005), Khoronenko CRI (OR = 3254.3; 95% CI 64.33-164,638; p = 0.0001), MICA (OR = 1.628; 95% CI 1.156-2.292; p = 0.005), creatininemia on the first postoperative day (OR = 1.023; 95% CI 1.010-1.061; p = 0.005), and propensity for bradycardia during surgery (OR = 0.945; 95% CI 0.908-0.983; p = 0.005). Combined analysis of Khoronenko's CRI and postoperative creatininemia provided a very good model: area under the ROC-curve - 0.823 (95% CI 0.728-0.641; p = 0.0002).Conclusion. All studied CRIs can be used to predict posthospital cardiac events; however, the most promising is a joint assessment of Khoronenko's CRI and postoperative creatinemia.

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Section: Discussionunclassified

Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

Соколов

Lyuboshevsky

Староверов

et al. 2021

Vestn. anesteziol. reanimatol.

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“…Как оказалось, вероятность ИМ возрастает по мере увеличения ЧСС в раннем послеоперационном периоде и снижения систолического АД в ходе вме-шательства, что подтверждает работы других авторов [17]. Механизм воздействия этих факторов представляется очевидным -повышение потребности миокарда в кислороде в условиях тахикардии и снижение его доставки при кровопотере, падении сердечного выброса и системного АД.…”

Section: Discussionunclassified

Postoperative myocardial infarction in lung cancer patients with: incidence rate, clinical features, prognostic factors

et al. 2020

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Aim. To study the incidence, clinical features and predictors of postoperative myocardial infarction (MI) after lung cancer surgery.Material and methods. The retrospective analysis included 2051 patients (1373 males and 678 females, mean age, 65,5 [62-69] years), who underwent thoracotomy for non-small cell lung cancer. At the first stage, the incidence rate of postoperative MI (%) was calculated with 95% confidential interval (CI) in relation to sex, age and extent of surgery. At the second stage, the case-control study was carried out in groups with MI revealed on the first stage (n=33) and without MI (n=130), formed by individual criteria-based matching. A comparative intergroup analysis was performed and prognostic value of 60 clinical perioperative indicators was assessed by odds ratio (OR). The features associated with MI in the univariateregression model were introduced into multivariate stepwise logistic regression. Independent MI predictors was revealed.Results. The postoperative IM incidence rate amounted to 1,61 [0,67-1,76]%. MI was more frequently diagnosed in men than women (0,29%), and after pneumonectomy (3,92%) compared with less operative extent (0,37%). MI was associated with comorbidities, smoking intensity, right pneumonectomy, preoperative increase in white blood cells, neutrophils and monocytes, blood loss volume, surgery duration, postoperative heart rate, preoperative decrease in serum total protein, postoperative haemoglobin, haematocrit, red blood cells decrease, and intraoperative blood pressure (BP). By means of multivariate logistic regression, the following factors with most accurate MI prediction were established: postoperative heart rate (OR, 4,06 [95% CI 1,58-10,43]), Sokolow-Lyon index (OR, 1,54 [95% CI 1,14-2,07]), ACS-NSQIP value for cardiac complications (OR, 3,86 [95% CI 1,36-10,92]), preoperative serum total protein (OR, 0,17 [95% CI 0,040,71]) and white blood cells (CR 1,54 [95% CI 1,03-2,31]), minimal intraoperative systolic BP (OR, 0,35 [95% CI 0,15-0,83]).Conclusion. Postoperative MI incidence in lung cancer patients accounts for 1,61%. Following independent predictors for postoperative MI were established: Sokolow-Lyon index, preoperative serum total protein and leukocytes levels, ACS-NSQIP value, minimal intraoperative systolic BP and postoperative heart rate.

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“…Результаты работы показали, что хирургическое лечение рака лёгкого в 1,6 % осложняется ИМ и в 1,1 %острой ишемией миокарда. Полученные нами данные, в целом, соответствуют литературным сведениям, согласно которым частота периоперационного ИМ варьировала в широких пределах от 0,09 % до 7,0 % [1,14,15,16]. Однако указанная выше распространённость была рассчитана для всех внесердечных операций, включая малые операции и пациентов низкого сердечно-сосудистого риска.…”

Section: Discussionunclassified

“…Имеющиеся данные позволяют предполагать, что ИМпST, означающий обширное трансмуральное поражение миокарда, ассоциирован с бóльшим объёмом хирургического вмешательства и бóльшей распространённостью опухоли. При меньшем хирургическом риске и в отсутствие онкологического заболевания, напротив, отмечено преобладание послеоперационных ИМбпST [14]. Мы не обнаружили ранее опубликованных данных о соотношении вариантов ИМ при хирургическом лечении рака лёгкого.…”

Section: Discussionunclassified

“…Налицо атипичность клинической картины: боли/дискомфорт за грудиной отметили всего два человека из 56 (3,6 %). Ранее этот факт отмечен и другими исследователями [14]. Вероятно, эти особенности и явились причиной крайне высокой госпитальной летальности от ИМ (86,4 % от ИМпST и 27,3 % от ИМбпST).…”

Section: Discussionunclassified

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Postoperative Cardiac Ischemic Complications in Lung Cancer Patients

Большедворская

Протасов

Батороев

et al. 2019

Acta biomedica scientifica

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Background. Perioperative myocardial ischemia often complicates extracardiac surgery. The problems of its prediction, diagnostics, treatment and prevention are not solved. Frequency, structure and clinical features of cardiac ischemic complications of surgical treatment of lung cancer are not well understood.The aim of the study was to investigate the frequency of postoperative myocardial infarction and myocardial ischemia in the surgical treatment of patients with non-small cell lung cancer.Methods. The frequency (%) of myocardial infarction (MI) with and without ST segment elevation of electrocardiogram, acute myocardial ischemia in a complete sample of cancer patients (n = 2051) who underwent treatment for non-small cell lung cancer for the last 10 years was calculated. By comparing the relative indicators and calculating the Odds Ratio (OR), we studied the relationship between the cardiac ischemic events with age, type of surgery, prevalence and localization of the tumour. The clinical manifestations and pathomorphology of postoperative myocardial infarction were analysed.Results. Cardiac ischemic complications of thoracotomy for lung cancer occurred in 2.73 % (95% CI 1.98–3.48) cases. Myocardial infarction with ST segment elevation was recorded in 1.07 % (95% CI 0.58–1.57) patients, MI without ST segment elevation – in 0.54 % (95% CI 0.17–0.9), myocardial ischemia – in 1.12 % (95% CI 0.62–1.63). An increase in the frequency of ischemic events after pneumonectomy was observed compared with lobectomy (OR 6.5, 95% CI 3.5–12.2) and after right-sided pneumonectomy compared with left-sided one (OR 3.2, 95% CI 1.6–6.3), and also the age over 70. Hospital mortality from MI was 39.3 %. According to autopsies of patients who died of МI, coronary atherothrombosis was detected in 2 of 22 cases.Conclusion. In the surgical treatment of non-small cell lung cancer, cardiac ischemic events develop in 2.73 % of patients. The greatest risk is associated with right-sided pneumonectomy.

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Intraoperative Risk Factors of Myocardial Infarction in Non-Cardiac Surgeries

Cited by 12 publications

References 8 publications

Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

Postoperative myocardial infarction in lung cancer patients with: incidence rate, clinical features, prognostic factors

Postoperative Cardiac Ischemic Complications in Lung Cancer Patients

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