The incidence of perioperative myocardial infarction in general vascular surgery

L. M. Taylor, R. A. Yeager, Gregory (Greg) Moneta, Donald McConnell, J. M. Porter

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

In a 1-year period all patients undergoing general vascular surgery (491 patients, 534 procedures) underwent monitoring by creatine phosphokinase isoenzymes and electrocardiograms (ECG) to detect perioperative myocardial infarction. Only those patients with severe symptomatic coronary artery disease (31 patients, 5.8%) characterized by unstable angina pectoris, uncontrolled arrhythmia, or severe congestive heart failure had any testing for coronary artery disease beyond history, physical examination, and ECG. Only three patients (0.5%) had prophylactic coronary artery bypass performed before general vascular procedures. Twenty-one (3.9%) myocardial infarctions (five asymptomatic, detected by enzymes only, and 16 symptomatic, four of which were fatal) were associated with the 534 procedures (aorta 105, carotid 87, infrainguinal bypass 207, extraanatomic 51, other 84). Eight noncardiac perioperative deaths occurred. All operative deaths (12 of 534, 2.2%) including all four fatal myocardial infarctions occurred associated with surgery on an urgent or emergency basis (12 of 249 procedures, urgent/emergent operative mortality rate 4.8%). No operative deaths and no fatal myocardial infarctions associated with the 285 elective procedures occurred. Nine of the 17 nonfatal myocardial infarctions (53%) also occurred after urgent/emergent procedures. The rate of perioperative myocardial infarctions (eight of 285, 2.8%) after elective surgery in this patient series is no different from that reported by multiple recent authors advocating widespread screening for and prophylactic treatment of coronary artery disease before general vascular surgery. Our experience confirms the therapeutic approach that expensive and invasive coronary screening programs in patients to undergo vascular operations should be limited to carefully selected patients with severely symptomatic coronary disease.

Original languageEnglish (US)
Pages (from-to)52-61
Number of pages10
JournalJournal of Vascular Surgery
Volume15
Issue number1
StatePublished - 1992

Fingerprint

Blood Vessels
Myocardial Infarction
Incidence
Coronary Artery Disease
Electrocardiography
Unstable Angina
Creatine Kinase
Coronary Artery Bypass
Isoenzymes
Physical Examination
Coronary Disease
Aorta
Cardiac Arrhythmias
Emergencies
Heart Failure
History
Mortality
Enzymes
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Taylor, L. M., Yeager, R. A., Moneta, G. G., McConnell, D., & Porter, J. M. (1992). The incidence of perioperative myocardial infarction in general vascular surgery. Journal of Vascular Surgery, 15(1), 52-61.

The incidence of perioperative myocardial infarction in general vascular surgery. / Taylor, L. M.; Yeager, R. A.; Moneta, Gregory (Greg); McConnell, Donald; Porter, J. M.

In: Journal of Vascular Surgery, Vol. 15, No. 1, 1992, p. 52-61.

Research output: Contribution to journalArticle

Taylor, LM, Yeager, RA, Moneta, GG, McConnell, D & Porter, JM 1992, 'The incidence of perioperative myocardial infarction in general vascular surgery', Journal of Vascular Surgery, vol. 15, no. 1, pp. 52-61.
Taylor, L. M. ; Yeager, R. A. ; Moneta, Gregory (Greg) ; McConnell, Donald ; Porter, J. M. / The incidence of perioperative myocardial infarction in general vascular surgery. In: Journal of Vascular Surgery. 1992 ; Vol. 15, No. 1. pp. 52-61.
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