Incidence of perioperative myocardial infarction and cardiac death after vascular surgery
|
Surgery Type Categories |
Total N |
Incidence of MI |
Mortality |
|
Carotid endarterectomy (total) |
2,437 |
34/2,437 = 1.4% |
2/2,437 = 0.08% |
|
2,349 |
||
|
17 |
||
|
66 |
||
|
5 |
||
|
Aortic surgery prosthetic grafts (total) |
1,934 |
37/1,934 = 1.91% |
10/1,934 = 0.52% |
|
Thoracic (total) |
332 |
4/332 = 1.2% |
3/332 = 0.9% |
|
139 |
||
|
16 |
||
|
88 |
||
|
89 |
||
|
Abdominal (total) |
1,602 |
33/1,602 = 2.06% |
7/1,602 = 0.44% |
|
Aorto-bi-iliac |
1,300 |
||
|
Aorto-bi-femoral |
244 |
||
|
Aorto-iliac - aorto-femoral |
58 |
||
|
Peripheral vascular surgery (total) |
2,577 |
36/2,577 = 1.4% |
10/2,577 = 0.4% |
|
Peripheral vascular reconstructive surgery (total) |
1,246 |
30/1,246=2.4% |
6/1,246 = 0.48% |
|
119 |
||
|
180 |
||
|
61 |
||
|
439 |
||
|
270 |
||
|
177 |
||
|
Amputations (total) |
1,331 |
6/1,331 = 0.45% |
4/1,331 =0.30% |
|
332 |
||
|
267 |
||
|
477 |
||
|
255 |
||
|
Total |
6,948 |
107/6,948 = 1.54% |
22/6,948 = 0.31% |
*Performed as primary procedure, not as a part of thoraco-abdominal aneurysm repair; † Includes procedures performed for reconstruction of either superior (n=48) or inferior (n=40) mesenteric arteries.
Summary of causes of death in patients who suffered perioperative myocardial infarction and in control group
|
Pt |
Age/Sex |
Surgery |
POD-MI |
POD Death |
Cause of Death* |
|
PMI group |
|||||
|
63/M |
AARS |
0 |
1 |
Massive blood loss, hyperkalemia, severe hypotension |
|
|
74/F |
PVS |
5 |
5 |
Cardiogenic shock, dysrhythmia (ventricular) |
|
|
72/M |
PVS |
1 |
11 |
Cardiogenic shock |
|
|
84/F |
PVS |
1 |
3 |
Cardiogenic shock followed by asystole |
|
|
79/M |
PVS |
0 |
0 |
Hemodynamic instability, ventricular dysrhythmia, ventricular fibrillation |
|
|
65/M |
AARS |
0 |
1 |
Acute severe hypotension, cardiogenic shock, asystole |
|
|
69/M |
TARS |
0 |
1 |
Acute severe hypotension, cardiogenic shock |
|
|
80/F |
PVS |
1 |
2 |
Postoperative acute myocardial ischemia, cardiac arrest during unsuccessful PTCA |
|
|
72/M |
AARS |
0 |
0 |
Hypotension, ventricular fibrillation |
|
|
77/F |
PVS |
0 |
38 |
Dysrhythmia, CHF, MSOF |
|
|
69/M |
TARS |
0 |
1 |
Acute intraoperative hypotension, ECG c/w acute MI, postoperatively ARDS, ARF |
|
|
82/M |
AARS |
1 |
3 |
Acute hypotension requiring vasopressor support, ARDS |
|
|
72/M |
PVS |
1 |
33 |
Cardiogenic shock |
|
|
84/F |
PVS |
1 |
1 |
Cardiogenic shock |
|
|
68/M |
CEA |
1 |
5 |
Hypotension requiring vasoactive support |
|
|
68/M |
AARS |
1 |
18 |
Ventricular dysrhythmia, ARF, septic shock, gastrointestinal bleeding |
|
|
70/M |
AARS |
0 |
24 |
Intraoperative MI, urgent partially successful PTCA, postoperatively long-term mechanical (IABP) and vasopressor support, ARF, gastrointestinal bleeding |
|
|
72/M |
PVS |
3 |
3 |
Autopsy confirmed massive acute MI |
|
|
77/M |
CEA |
1 |
39 |
Cardiac dysrhythmia, severe hypotension, cardiac arrest |
|
|
73/M |
TARS |
0 |
2 |
Ventricular tachycardia, cardiogenic shock, asystole |
|
|
85/M |
PVS |
2 |
30 |
CHF after MI, long-term vasoactive support, sepsis |
|
|
76/M |
AARS |
1 |
45 |
Ventricular dysrhythmia, MSOF |
|
|
Control Group |
|||||
|
75/F |
CEA |
--- |
8 |
Sudden asystole without evidence of acute MI |
|
|
64/M |
AARS |
--- |
77 |
ARDS, wound dehiscence (steroid dependence for COPD), septicemia, ARF |
|
|
74/M |
TARS |
--- |
8 |
ARSD, celullitis/fasciitis, sepsis, acute hemorrhage, shock |
|
|
73/F |
PVS |
--- |
19 |
ARF, acidosis, CHF (no evidence of MI) |
|
*Description is based on terminology used in physicians' notes. F, female; M, male; Age (in years); POD-MI, postoperative day when myocardial infarction was diagnosed; MSOF, multisystem organ failure; CHF, congestive heart failure; IABP, intraaortic balloon pump, ARDS, adult respiratory distress syndrome; ARF, acute renal failure; PTCA, percutaneous transluminal coronary angioplasty; AARS abdominal aortic reconstructive surgery; TARS, thoracic aortic reconstructive surgery; PVS, peripheral vascular surgery.