Key result
Infrainguinal bypass independently predicted 6-month mortality after major vascular surgery (OR 2.92, P=0.02), while diabetes was the sole predictor of overall mortality (OR 1.94, P=0.001).
Why the study?
What are the predictors of myocardial ischemia and mortality after major vascular surgery in a community hospital setting?
Observational (n=190)
No
What are the predictors of myocardial ischemia and mortality after major vascular surgery in a community hospital setting?
Odds Ratio: 2.92
p-value: p=0.02
In patients undergoing major vascular surgery, infrainguinal bypass and diabetes are significant predictors of mortality, while postoperative troponin elevation likely conveys a 6-month mortality risk.
May warrant closer post-op monitoring after infrainguinal bypass; leaves open targeted interventions in community vascular cohorts.
Cardiovascular disease is the leading cause of perioperative morbidity and mortality after vascular surgery. The purpose of this study was to identify risk factors for myocardial ischemia after vascular surgery and to investigate a potential association of ischemia with mortality in a community hospital setting. A retrospective review was conducted after 190 major vascular procedures. Electrocardiogram (ECG) results and troponin I levels were obtained serially during the first 24 postoperative hours. Outcomes analyzed were ischemic ECG changes, troponin I level more than 2 ng/mL, 6-month mortality, and overall survival. The authors investigated any association of these outcomes with each other and the type of operation, history of coronary artery disease, diabetes, recent coronary intervention, age older than 70 years, or postoperative symptoms. Twenty-seven (14%) patients experienced ischemic ECG changes. Twenty-one (11%) patients experienced troponin I elevation. Univariate analysis revealed a history of coronary artery disease, diabetes, concerning symptoms, and troponin elevation to be predictive of ECG change (P < 0.05). ECG change and symptoms were predictive of troponin elevation (P < 0.01). Cox multivariate analysis revealed only infrainguinal bypass to predict 6-month mortality (odds ratio = 2.92, P = 0.02). Diabetes was the sole predictor of overall mortality (odds ratio = 1.94, P = 0.001). Nonsustained ischemic postoperative ECG changes during the first 24 postoperative hours do not independently influence 6-month or overall mortality after major vascular surgery. Postoperative troponin elevation likely conveys a mortality risk in the subsequent 6 months. In the community hospital setting, midterm survival rates after vascular surgery equivalent to those in higher volume centers can be achieved. Patients undergoing infrainguinal bypass and diabetics continue to be the most moribund vasculopaths.
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Blecha et al. (2007) conducted an observational in Major vascular surgery (n=190). Infrainguinal bypass vs. Other major vascular procedures was evaluated on 6-month mortality (OR 2.92, p=0.02). Infrainguinal bypass independently predicted 6-month mortality after major vascular surgery (OR 2.92, P=0.02), while diabetes was the sole predictor of overall mortality (OR 1.94, P=0.001).
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