title: The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A large urban Veterans Affairs hospital.
  
  
  METHODS
  A total of 1487 men older than 40 years undergoing major, nonemergent, noncardiac operations.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Veterans Affairs Medical Center, Houston, Texas.
authors.forename: C M
authors.initials: CM
authors.lastname: Ashton
authors.forename: N J
authors.initials: NJ
authors.lastname: Petersen
authors.forename: N P
authors.initials: NP
authors.lastname: Wray
authors.forename: C I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: J K
authors.initials: JK
authors.lastname: Dunn
authors.forename: L
authors.initials: L
authors.lastname: Wu
authors.forename: J M
authors.initials: JM
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000150:complications; D003327:Coronary Disease / Q000150:complications; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D014652:Vascular Diseases / Q000150:complications