title: Clinical impact of perioperative myocardial infarction after pancreatic surgery.
abstract: BACKGROUND
  The aim of this study was to evaluate the incidence, clinical impact and outcome of perioperative myocardial infarction (PMI) in patients undergoing pancreatic surgery.
  
  
  METHODS
  A data of 1,625 patients undergoing pancreatic resection were prospectively collected and analysed with regard to PMI. Demographic aspects, co-morbidities and clinical course were evaluated. Cardiac risk factors (ASA and NYHA), postoperative complications and mortality were compared in a match-pair analysis (1:3) with patients without PMI.
  
  
  RESULTS
  Twenty-nine patients with PMI after pancreatic surgery were identified. PMI occurred after all types of pancreatic operations and was observed most frequently (72.2%) within the first postoperative week. In a total of 90%, PMI fulfilled the criteria of non-STEMI. Nearly half of the patients (48%) were clinically asymptomatic. Both ASA III and heart failure were more frequent in patients with PMI. The in-hospital mortality was significantly increased after PMI (p < 0.002), with post-pancreatectomy haemorrhage (PPH) as the most relevant underlying risk factor.
  
  
  CONCLUSIONS
  PMI is a rare but severe complication after pancreatic operations, contributing significantly to in-hospital mortality. Clinical management mainly includes an anti-coagulant approach. This may be related with an increased risk for PPH. Therefore, the use of anti-coagulant drugs in the early postoperative period-especially in asymptomatic patients-should be critically evaluated.
authors.affiliation: Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany, dmitry.dovzhanskiy@gmx.de.
authors.forename: Dmitriy I
authors.initials: DI
authors.lastname: Dovzhanskiy
authors.forename: Thilo
authors.initials: T
authors.lastname: Hackert
authors.forename: Jens
authors.initials: J
authors.lastname: Krumm
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Jens
authors.initials: J
authors.lastname: Roggenbach
authors.forename: Stefan
authors.initials: S
authors.lastname: Hofer
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D010180:Pancreatectomy / Q000009:adverse effects; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D059035:Perioperative Period; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000925:Anticoagulants