Risk Factors in Surgical Patients with Verified Preoperative Myocardial Infarction

Abstract

A series of 89 surgical patients (1 11 operations) with preoperative myocardial infarction (MI) was analysed for factors predisposing to the development of a postoperative reinfarction. Six of them suffered postoperative MI, and three of these patients died. In the statistical analysis the following risk factors emerged: age over 60 years, anaemia, hypertension, and the fact that the previous MI had been posterior. Abdominal operations were more dangerous concerning reinfarction than other operations. In the other series of 11 deceased patients with postoperative reinfarction collected from the autopsy material, about the same risk factors were found. The most important factor seemed to be hypotension, which complicated the surgery. All 11 patients had arrhythmias in their preoperative electrocardiogram. Previously treated heart failure was present in five of these patients. Postoperative symptoms analysed in the first series suggest that if a patient with preoperative MI has arrhythmias, hypotension, dyspnoea, diffuse unlocalized pain or chest pain after sugery, he is very likely to have a reinfarction.

Non-protected carotid artery stent without angioplasty in high-risk patients with carotid and coronary artery disease undergoing cardiac surgery

“…Patients with coronary disease undergoing cardiac surgery are at higher risk of myocardial infarction if prolonged hypotension occurs during the procedure (7)(8)(9).…”

Can vascular surgery be performed soon after myocardial infarction?

“…This was also confirmed by Steen et al and Eerola et at. in patients with previous MI [2,15]. There was no relation to the type of anesthetic used to the cardiac complications.…”

“…Conversely, there were several studies in which a MI less than six months before operation was not a predictor of perioperative cardiac events. The time elapsed since the MI was not a significant factor in a study by Eerola et al, in which 89 patients underwent 111 operations; 29 operations were in patients with previous MI within 6 months [15]. Foster et al did not find that history of prior MI, including one within six months of the noncardiac procedure, had a statistically significant independent association with operative mortality or cardiac morbidity [16].…”

Perioperative Myocardial Infarction

“…This has also been identified as a risk factor [26,36,40,80]. In addition, Pasternak and colleagues [75] found a higher infarction rate in patients with a low preoperative ejection fraction (less than 35%).…”

“…Steen, Tinker and Tarhan [94] found no significant correlation between the PMI rate and the site of a previous MI. On the other hand, Eerola and colleagues [36] found that a previous posterior infarction was a significant risk factor, while Arkins, Smessaert and Hicks [3] found lower mortality rates if earlier infarction was subendocardial.…”