title: Are the incidences of cardiac events during noncardiac surgery in Japan the same as in the United States and Europe?
abstract: In Japan, an ever-present problem in the preoperative evaluation of patients with ischemic heart disease is that although such evaluations are based on Western data, these data serve as the basis for determining perioperative risk in Japanese patients. To remedy this problem, the Cardiac Ischemia and Anesthesia Research Committee was formed in 1997 and has conducted studies of perioperative complications in noncardiac surgery in Japan. In two retrospective studies in 1997, the proportions of patients with ischemic heart disease were 3.9% and 3.1%, approximately one tenth the rates reported in Europe and the United States. The incidences of perioperative cardiac complications in patients with ischemic heart disease were 16.4% and 13.2%, not widely divergent from rates reported in Europe and the United States. To investigate the baseline characteristics involved in perioperative complications, we conducted a prospective study of 237 patients classified as having intermediate risk for perioperative cardiac complications according to the American College of Cardiology/American Heart Association Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery. We found that the prominent factor in intraoperative cardiac complications was the presence of hypertension (odds ratio = 2.911). Factors contributing to postoperative cardiac complications included those reflecting coronary lesion severity and cardiac dysfunction (history of heart failure; odds ratio = 6.884, coronary risk index grade; odds ratio = 2.884, and a history of intervention; odds ratio = 4.774).
authors.affiliation: Department of Anesthesiology, Cancer Institute Hospital; Department of Anesthesiology, Faculty of Medicine, University of Yamanashi; Department of Anesthesiology, Tokyo Women's Medical University; Department of Anesthesiology, Tokyo Metropolitan Toshima Hospital; Department of Anesthesiology, Juntendo University School of Medicine; Department of Anesthesiology, Division of Critical Care, National Cancer Center Hospital; Department of Anesthesiology, Nippon Medical School; Department of Anesthesiology, Tokyo Medical University, Hachioji Medical Center; Department of Anesthesiology, Yokohama City University School of Medicine; Department of Anesthesiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Seki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kashimoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagata
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoshioka
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ishiguro
authors.forename: Kinya
authors.initials: K
authors.lastname: Nishimura
authors.forename: Osamu
authors.initials: O
authors.lastname: Honda
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Akibumi
authors.initials: A
authors.lastname: Omi
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Ogihara
authors.forename: Keiko
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Motoyo
authors.initials: M
authors.lastname: Iwade
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamada
authors.forename: Minoru
authors.initials: M
authors.lastname: Nomura
authors.forename: Junzo
authors.initials: J
authors.lastname: Takeda
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology*; D005060:Europe; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States