Morbidity and Mortality Analysis after Noncardiac Surgery in Patients with Prior Myocardial Infarction.

Lim,  Eui Sung; Han,  Jong In; Kim,  Chi Hyo; Lee,  Guie Young; Kang,  Sin Young

doi:2005.49.3.321

Clinical Research Article

Korean Journal of Anesthesiology 2005;49(3):321-326.
DOI: https://doi.org/10.4097/kjae.2005.49.3.321

Morbidity and Mortality Analysis after Noncardiac Surgery in Patients with Prior Myocardial Infarction.

Eui Sung Lim, Jong In Han, Chi Hyo Kim, Guie Young Lee, Sin Young Kang

Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea. hanji@ewha.ac.kr

Abstract

BACKGROUND
Patients with a prior myocardial infarction who undergo noncardiac surgery have a higher risk of perioperative morbidity and mortality. Therefore, this study was designed to assess the outcomes after non-cardiac surgery in patients who had a previous myocardial infarction.
METHODS
Ninety three patients who had a prior myocardial infarction and underwent noncardiac surgery were included in this study. The patients were divided as follows: the Complication group versus the Non-Complication group. A retrospective analysis was performed to determine if age, gender, ejection fraction, prior coronary revascularization, ASA physical status, operation time and type, perioperative vital signs, cardiac risk factor, preoperative medications and coronary multivessel disease influence the perioperative morbidity and mortality.
RESULTS
Fourteen of the 93 patients (15.1%) had perioperative complications, of which 3 (3.2%) were fatal. All fatal patients had undergone noncardiac surgery within 3 months after the previous coronary revascularization. The incidence of intraoperative tachycardia and oliguria, operation time and the ASA physical status were longer and greater in the Complication group (P<0.05). Otherwise there were no significant differences between the two groups.
CONCLUSIONS
The incidence of intraoperative tachycardia and oliguria, the operation time and ASA physical status influence the outcomes after noncardiac surgery of patients with a prior myocardial infarction. In addition, the interval between the coronary revascularization procedure and the noncardiac surgery has a major impact on postoperative mortality. However, prospective multi-center studies will be needed to determine the effects of several variables.

Key Words: coronary arterial disease; coronary artery bypass graft; myocardial infarction; noncardiac surgery; percutaneous transmural coronary angioplasty; perioperative mortality