Risk Factors in Surgical Patients with Verified Preoperative Myocardial Infarction

Abstract

A series of 89 surgical patients (111 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 surgery, he is very likely to have a reinfarction.

Predictors and Timing of Hypotension and Bradycardia after Carotid Artery Stenting

“…In fact, patients with coronary disease undergoing cardiac or noncardiac surgery are at higher risk of myocardial infarction (MI) if prolonged hypotension occurs during the procedure. [7][8][9][10] It has also been suggested that hypotension associated with CAS increases the risk of cerebrovascular events in impairing the distal washout of residual emboli not intercepted by the protection device. 2,11 The concern about the potential harmfulness of hypotension and bradycardia during or after CAS has enhanced the scientific interest about its risk factors.…”

Postoperative Myocardial Reinfarction Following Lumbar Spine Surgery

“…MI indicates myocardial infarction; NA, not applicable. Patients were stratified into 5 groups: those who experienced an initial MI 0-3 months before undergoing lumbar surgery (0-3), those who experienced an initial MI 4-6 months before undergoing lumbar surgery (4-6), those who experience an initial MI 7-12 months before surgery (7)(8)(9)(10)(11)(12), those who experienced an initial MI 13-24 months before undergoing lumbar surgery (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), and those who experienced an initial MI 25+ months before undergoing lumbar surgery. MI indicates myocardial infarction; NA, not applicable.…”

“…6 While large cohort studies have demonstrated that 0.1%-0.7% of patients experience MI after surgery, 7,8 1-week postoperative reinfarction rates have been documented at rates around 7%. 9,10 Furthermore, Topkins and Artusio 8 demonstrated that patients experiencing a postoperative infarction had a mortality rate of 26.5% while patients experiencing a postoperative reinfarction had a mortality rate of 70%.…”