Perioperative myocardial ischemia in coronary artery disease patients undergoing abdominal nonvascular surgery.
BACKGROUND
The incidence of perioperative myocardial ischemia (PMI) is the highest in patients who have coronary artery disease, and it is the best predictor of intrahospital morbidity and mortality.


OBJECTIVE
To identify predictors of PMI in patients who have coronary artery disease and are undergoing abdominal nonvascular surgery.


METHODS
A prospective, observational, clinical study of 111 consecutive patients with angiographically verified coronary artery disease, scheduled for open abdominal nonvascular surgery, was conducted. Patients received general anesthesia and were monitored by continuous electrocardiogram during surgery and immediately postsurgery (72 h period) in the intensive care unit at the University Clinical Center (Belgrade, Serbia). All of the patients had 12-lead electrocardiography immediately after the surgery, on postoperative days 1, 2 and 7, and one day before discharge from hospital. The patients were monitored until the 30th postoperative day.


RESULTS
A total of 24 predictors for PMI were analyzed. The Pearson's chi(2) test and a binomial logistic regression model were used for statistical analysis. A significant difference in the incidence of PMI was found in the coronary artery disease patients with an associated risk factor (14 of 24 risk factors) compared with those without the risk factor. In particular, a highly significant difference in the incidence of PMI was found in coronary artery disease patients with angina pectoris, compared with those without angina pectoris.


CONCLUSIONS
Using the multivariate logistic regression analysis, angina pectoris was an independent predictor of PMI.
Karapandzic
Vesna M
VM
Intensive Care Unit, University Clinical Center of Serbia, Belgrade, Serbia.
Vujisic-Tesic
Bosiljka D
BD
Pesko
Predrag M
PM
Rankovic
Vitomir I
VI
Milicic
Biljana R
BR