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1 April 1993 | Volume 118 Issue 7 | Pages 504-510
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.
Author and Article Information
From the Veterans Affairs Medical Center, Houston, Texas.
ARTICLE
The Incidence of Perioperative Myocardial Infarction in Men Undergoing Noncardiac Surgery
Requests for Reprints: Carol Ashton, MD, MPH, Veterans Affairs Medical Center (111), 2002 Holcombe Boulevard, Houston, TX 77030.
Acknowledgments: The authors thank Drs. James Alexander and Gene Guinn for their advice and encouragement.
Grant Support: By the American Heart Association, Texas Affiliate (87G-173) and the Center for Quality of Care and Utilization Studies: a Veterans Affairs Health Services Research and Development Field Program.
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