Relationship of unrecognised myocardial infarction, diabetes mellitus and type of surgery to postoperative cardiac outcomes in vascular surgery.
OBJECTIVE
to evaluate preoperative clinical, surgical and instrumental variables as predictors of postoperative cardiac events in patients undergoing different types of elective major vascular surgery.


METHODS
on the basis of an algorithm including clinical and test echocardiographic data, we prospectively stratified 604 consecutive patients into low, intermediate and high-risk groups. The value of the variables in predicting postoperative cardiac events was assessed by means of multivariate analysis.


RESULTS
there were 16 major postoperative cardiac events and six of 16 postoperative deaths were cardiac related (1%). Significant predictors of cardiac complications were unrecognised myocardial infarction (odds ratio - (OR) 5.6), coronary artery disease (OR 2.5), severe hypertension (OR 2.1) and peripheral vascular surgery (OR 1.9). In the intermediate-risk group, the best correlates with cardiac complications were unrecognised myocardial infarction (OR 3.3) and diabetes (OR 2.5).


CONCLUSIONS
our results suggest the importance of identifying patients with unrecognised ischaemic heart disease and of using aggressive perioperative protocols for managing diabetic patients undergoing peripheral vascular procedures.
Roghi
A
A
Department of Cardiology, National Research Council Section of Milan, Niguarda Cá Granda Hospital, Milan, Italy.
Palmieri
B
B
Crivellaro
W
W
Faletra
F
F
Puttini
M
M
D000368:Aged; D000465:Algorithms; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D004452:Echocardiography; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D012306:Risk; D016019:Survival Analysis; D014656:Vascular Surgical Procedures