Silent myocardial ischemia monitoring predicts late as well as perioperative cardiac events in patients undergoing vascular surgery.
In a previous study we have shown that perioperative monitoring for silent myocardial ischemia can noninvasively identify those patients undergoing peripheral vascular surgery who are at significantly increased risk for perioperative myocardial infarction. In the present study a group of 385 patients undergoing peripheral vascular surgery was studied long-term as well as short-term to determine whether perioperative monitoring for silent ischemia can identify those patients who are at significantly increased risk of late cardiac death or late cardiac complications as well as those patients at increased risk of perioperative myocardial infarction. All patients were monitored before, during, and after operation and were divided into two groups on the basis of results of monitoring: patients whose total duration of silent ischemia as a percentage of the total duration of perioperative monitoring was 1% or greater (group I, n = 120) and those for whom this value was less than 1% (group II, n = 265). Among patients in group I 13.3% (16 of 120) suffered a perioperative myocardial infarction in contrast to only 1.1% (3 of 265) patients in group II (p less than 0.001). Multivariate logistic regression analysis of preoperative and perioperative characteristics showed that the presence of a total perioperative percent time ischemic 1% or greater and age were the only significant predictors of perioperative myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
Pasternack
P F
PF
Department of Medicine, New York University Medical Center 10016.
Grossi
E A
EA
Baumann
F G
FG
Riles
T S
TS
Lamparello
P J
PJ
Giangola
G
G
Yu
A Y
AY
Mintzer
R
R
Imparato
A M
AM
D000368:Aged; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D008991:Monitoring, Physiologic; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012044:Regression Analysis; D016019:Survival Analysis