Key result
Post-MI noncardiac surgery carries a ~15% complication rate, driven by operative time and physiological stress.
Why the study?
Patients with a prior myocardial infarction undergoing noncardiac surgery face a higher risk of perioperative morbidity and mortality, motivating an assessment of perioperative outcomes and their clinical predictors in this population.
What perioperative clinical factors and intervals after prior coronary revascularization influence morbidity and mortality in patients with prior myocardial infarction undergoing elective noncardiac surgery?
Cohort (n=93)
No
What perioperative clinical factors and intervals after prior coronary revascularization influence morbidity and mortality in patients with prior myocardial infarction undergoing elective noncardiac surgery?
Answers are grounded in this paper and cite their sources.
In patients with a prior myocardial infarction undergoing noncardiac surgery, higher ASA physical status, longer operation duration, intraoperative tachycardia, and oliguria significantly increase perioperative complications, and undergoing surgery within 3 months of coronary revascularization carries a high risk of mortality.
Background: Patients with a prior myocardial infarction who undergo noncardiac surgery have a higher risk of perioperative morbidity and mortality.Therefore, this study was designed to assess the outcomes after non-cardiac surgery in patients who had a previous myocardial infarction.Methods: Ninety three patients who had a prior myocardial infarction and underwent noncardiac surgery were included in this study.The patients were divided as follows: the Complication group versus the Non-Complication group.A retrospective analysis was performed to determine if age, gender, ejection fraction, prior coronary revascularization, ASA physical status, operation time and type, perioperative vital signs, cardiac risk factor, preoperative medications and coronary multivessel disease influence the perioperative morbidity and mortality.Results: Fourteen of the 93 patients (15.1%) had perioperative complications, of which 3 (3.2%)were fatal.All fatal patients had undergone noncardiac surgery within 3 months after the previous coronary revascularization.The incidence of intraoperative tachycardia and oliguria, operation time and the ASA physical status were longer and greater in the Complication group (P ＜ 0.05).Otherwise there were no significant differences between the two groups.Conclusions: The incidence of intraoperative tachycardia and oliguria, the operation time and ASA physical status influence the outcomes after noncardiac surgery of patients with a prior myocardial infarction.In addition, the interval between the coronary revascularization procedure and the noncardiac surgery has a major impact on postoperative mortality.However, prospective multi-center studies will be needed to determine the effects of several variables.(Korean J Anesthesiol 2005; 49: 321∼6)
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Lim et al. (2005) conducted a cohort in Prior myocardial infarction undergoing elective noncardiac surgery (n=93). Noncardiac surgery and perioperative clinical factors (ASA physical status, operation time, intraoperative tachycardia and oliguria, prior coronary revascularization) vs. Complication group (n=14) vs. Non-Complication group (n=79) was evaluated on Perioperative complications (morbidity) and mortality (p=< 0.05). Patients with prior myocardial infarction undergoing noncardiac surgery had a 15.1% complication rate and 3.2% mortality rate, significantly associated with longer operation time, higher ASA class, and intraoperative tachycardia or oliguria (P<0.05).
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