The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery
Department of Quantitative Health Sciences
Medical Subject Headings
Adult; Aged; Cardiac Output, Low; Coronary Disease; Humans; Incidence; Intraoperative Complications; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Prospective Studies; Risk Factors; Vascular Diseases
Bioinformatics | Biostatistics | Epidemiology | Health Services Research
OBJECTIVES: To determine the incidence of and risk factors for perioperative myocardial infarction with noncardiac surgery and to test the accuracy of a risk stratification system.
DESIGN: Prospective cohort study.
SETTING: A large urban Veterans Affairs hospital.
PARTICIPANTS: A total of 1487 men older than 40 years undergoing major, nonemergent, noncardiac operations.
MEASUREMENTS: Infarction was established by at least two of the following: development of new Q waves, typical change in creatine kinase MB, and positive technetium pyrophosphate scintigraphy. Patients were stratified preoperatively into high-, intermediate-, low-, and negligible-risk strata based on clinical markers corresponding to different levels of coronary artery disease prevalence.
MAIN RESULTS: Patients with coronary disease (high-risk stratum) had a 4.1% incidence of infarction (13 of 319; 95% CI, 1.8% to 6.4%); patients with peripheral vascular disease but no evidence of coronary disease (intermediate-risk stratum) had a 0.8% incidence (2 of 260, upper bound of CI, 2.0%); patients with high atherogenic risk factor profiles but no clinical atherosclerosis (low-risk stratum) had a 0% incidence (0 of 256, upper bound of CI, 1.2%). No cardiac deaths occurred in 652 men who had no atherosclerosis and low atherogenic risk factor profiles (the negligible-risk stratum). Factors independently associated with infarction included age more than 75 years (adjusted odds ratio, 4.77; CI, 1.17 to 19.41), signs of heart failure on the preoperative examination (adjusted odds ratio, 3.31; CI, 0.96 to 11.38), coronary disease (adjusted odds ratio, 10.39; CI, 2.27 to 47.46), and a planned vascular operation (adjusted odds ratio, 3.72; CI, 1.12 to 12.37).
CONCLUSIONS: Coronary artery disease is the major risk factor for perioperative infarction. The stratification scheme identifies subsets of patients with different risks, and finer within-stratum distinctions can be made using additional variables.
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Citation: Ann Intern Med. 1993 Apr 1;118(7):504-10.
Ashton, Carol M.; Petersen, Nancy J.; Wray, Nelda P.; Kiefe, Catarina I.; Dunn, J. Kay; Wu, Louis; and Thomas, JoAnn M., "The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery" (1993). Quantitative Health Sciences Publications and Presentations. 158.