CORRELATION OF CLINICAL AND DEMOGRAPHIC FACTORS WITH THE OCCURRENCE OF MYOCARDIAL INFARCTION AND CARDIAC ARREST IN OLDER PATIENTS AFTER MAJOR ELECTIVE VASCULAR SURGERY
Abstract
The risk stratification as a part of preoperative preparation of patients involves a series of diagnostic and therapeutic procedures with the main objective of reducing peri/post-operative morbidity and mortality. The aim of the study was to identify a wide spectrum of preoperative clinical and demographic characteristics which were significantly associated with the occurrence of myocardial infarction and cardiac arrest (MICA) during six-month period after vascular surgical procedure, during 2017, 2018, 2019, the study included 144 patients (96 men-66.6 % and 48 women-33.3 %) over 65 years of age (average 70 years). MICA in the first six months after the intervention was associated with higher NYHA class (p < 0.001), previous coronary artery disease (p < 0.001), cardiomyopathy (p < 0.05) or previous myocardial infarction (p < 0.05), usage of calcium channel antagonists (p < 0.05) and antiplatelet drugs (p < 0.001), higher ASA score (p < 0.01), higher urea concentration (p < 0.01), lower ejection fraction (p < 0.001) and longer intensive care unit stay (p < 0.001). Using binary logistic regression method, multivariate analysis has identified previous coronary artery disease as a predictor of MICA occurrence (p < 0.01). In the multivariate Cox-regression model (χ2 = 71.515, p < 0.001), there were six independent predictors of survival without MICA. Previous coronary artery disease is most significant preoperative risk factor for MICA occurrence. Variables related to heart failure and high urea concentration are independent predictors for MICA.
References
Normal
0
false
false
false
EN-US
X-NONE
X-NONE
DefSemiHidden="false" DefQFormat="false" DefPriority="99"
LatentStyleCount="371">
UnhideWhenUsed="true" QFormat="true" Name="heading 2"/>
UnhideWhenUsed="true" QFormat="true" Name="heading 3"/>
UnhideWhenUsed="true" QFormat="true" Name="heading 4"/>
UnhideWhenUsed="true" QFormat="true" Name="heading 5"/>
UnhideWhenUsed="true" QFormat="true" Name="heading 6"/>
UnhideWhenUsed="true" QFormat="true" Name="heading 7"/>
UnhideWhenUsed="true" QFormat="true" Name="heading 8"/>
UnhideWhenUsed="true" QFormat="true" Name="heading 9"/>
Name="index 1"/>
Name="index 2"/>
Name="index 3"/>
Name="index 4"/>
Name="index 5"/>
Name="index 6"/>
Name="index 7"/>
Name="index 8"/>
Name="index 9"/>
UnhideWhenUsed="true" Name="toc 1"/>
UnhideWhenUsed="true" Name="toc 2"/>
UnhideWhenUsed="true" Name="toc 3"/>
UnhideWhenUsed="true" Name="toc 4"/>
UnhideWhenUsed="true" Name="toc 5"/>
UnhideWhenUsed="true" Name="toc 6"/>
UnhideWhenUsed="true" Name="toc 7"/>
UnhideWhenUsed="true" Name="toc 8"/>
UnhideWhenUsed="true" Name="toc 9"/>
Name="Normal Indent"/>
Name="footnote text"/>
Name="annotation text"/>
Name="header"/>
Name="footer"/>
Name="index heading"/>
UnhideWhenUsed="true" QFormat="true" Name="caption"/>
Name="table of figures"/>
Name="envelope address"/>
Name="envelope return"/>
Name="footnote reference"/>
Name="annotation reference"/>
Name="line number"/>
Name="page number"/>
Name="endnote reference"/>
Name="endnote text"/>
Name="table of authorities"/>
Name="macro"/>
Name="toa heading"/>
Name="List"/>
Name="List Bullet"/>
Name="List Number"/>
Name="List 2"/>
Name="List 3"/>
Name="List 4"/>
Name="List 5"/>
Name="List Bullet 2"/>
Name="List Bullet 3"/>
Name="List Bullet 4"/>
Name="List Bullet 5"/>
Name="List Number 2"/>
Name="List Number 3"/>
Name="List Number 4"/>
Name="List Number 5"/>
Name="Closing"/>
Name="Signature"/>
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
UnhideWhenUsed="true" Name="Body Text"/>
Name="Body Text Indent"/>
Name="List Continue"/>
Name="List Continue 2"/>
Name="List Continue 3"/>
Name="List Continue 4"/>
Name="List Continue 5"/>
Name="Message Header"/>
Name="Salutation"/>
Name="Date"/>
Name="Body Text First Indent"/>
Name="Body Text First Indent 2"/>
Name="Note Heading"/>
Name="Body Text 2"/>
Name="Body Text 3"/>
Name="Body Text Indent 2"/>
Name="Body Text Indent 3"/>
Name="Block Text"/>
Name="Hyperlink"/>
Name="FollowedHyperlink"/>
Name="Document Map"/>
Name="Plain Text"/>
Name="E-mail Signature"/>
Name="HTML Top of Form"/>
Name="HTML Bottom of Form"/>
Name="Normal (Web)"/>
Name="HTML Acronym"/>
Name="HTML Address"/>
Name="HTML Cite"/>
Name="HTML Code"/>
Name="HTML Definition"/>
Name="HTML Keyboard"/>
Name="HTML Preformatted"/>
Name="HTML Sample"/>
Name="HTML Typewriter"/>
Name="HTML Variable"/>
Name="Normal Table"/>
Name="annotation subject"/>
Name="No List"/>
Name="Outline List 1"/>
Name="Outline List 2"/>
Name="Outline List 3"/>
Name="Table Simple 1"/>
Name="Table Simple 2"/>
Name="Table Simple 3"/>
Name="Table Classic 1"/>
Name="Table Classic 2"/>
Name="Table Classic 3"/>
Name="Table Classic 4"/>
Name="Table Colorful 1"/>
Name="Table Colorful 2"/>
Name="Table Colorful 3"/>
Name="Table Columns 1"/>
Name="Table Columns 2"/>
Name="Table Columns 3"/>
Name="Table Columns 4"/>
Name="Table Columns 5"/>
Name="Table Grid 1"/>
Name="Table Grid 2"/>
Name="Table Grid 3"/>
Name="Table Grid 4"/>
Name="Table Grid 5"/>
Name="Table Grid 6"/>
Name="Table Grid 7"/>
Name="Table Grid 8"/>
Name="Table List 1"/>
Name="Table List 2"/>
Name="Table List 3"/>
Name="Table List 4"/>
Name="Table List 5"/>
Name="Table List 6"/>
Name="Table List 7"/>
Name="Table List 8"/>
Name="Table 3D effects 1"/>
Name="Table 3D effects 2"/>
Name="Table 3D effects 3"/>
Name="Table Contemporary"/>
Name="Table Elegant"/>
Name="Table Professional"/>
Name="Table Subtle 1"/>
Name="Table Subtle 2"/>
Name="Table Web 1"/>
Name="Table Web 2"/>
Name="Table Web 3"/>
Name="Balloon Text"/>
Name="Table Theme"/>
Name="List Paragraph"/>
Name="Intense Quote"/>
Name="Subtle Emphasis"/>
Name="Intense Emphasis"/>
Name="Subtle Reference"/>
Name="Intense Reference"/>
UnhideWhenUsed="true" Name="Bibliography"/>
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
Name="Grid Table 1 Light Accent 1"/>
Name="Grid Table 6 Colorful Accent 1"/>
Name="Grid Table 7 Colorful Accent 1"/>
Name="Grid Table 1 Light Accent 2"/>
Name="Grid Table 6 Colorful Accent 2"/>
Name="Grid Table 7 Colorful Accent 2"/>
Name="Grid Table 1 Light Accent 3"/>
Name="Grid Table 6 Colorful Accent 3"/>
Name="Grid Table 7 Colorful Accent 3"/>
Name="Grid Table 1 Light Accent 4"/>
Name="Grid Table 6 Colorful Accent 4"/>
Name="Grid Table 7 Colorful Accent 4"/>
Name="Grid Table 1 Light Accent 5"/>
Name="Grid Table 6 Colorful Accent 5"/>
Name="Grid Table 7 Colorful Accent 5"/>
Name="Grid Table 1 Light Accent 6"/>
Name="Grid Table 6 Colorful Accent 6"/>
Name="Grid Table 7 Colorful Accent 6"/>
Name="List Table 1 Light Accent 1"/>
Name="List Table 6 Colorful Accent 1"/>
Name="List Table 7 Colorful Accent 1"/>
Name="List Table 1 Light Accent 2"/>
Name="List Table 6 Colorful Accent 2"/>
Name="List Table 7 Colorful Accent 2"/>
Name="List Table 1 Light Accent 3"/>
Name="List Table 6 Colorful Accent 3"/>
Name="List Table 7 Colorful Accent 3"/>
Name="List Table 1 Light Accent 4"/>
Name="List Table 6 Colorful Accent 4"/>
Name="List Table 7 Colorful Accent 4"/>
Name="List Table 1 Light Accent 5"/>
Name="List Table 6 Colorful Accent 5"/>
Name="List Table 7 Colorful Accent 5"/>
Name="List Table 1 Light Accent 6"/>
Name="List Table 6 Colorful Accent 6"/>
Name="List Table 7 Colorful Accent 6"/>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-parent:"";
mso-padding-alt:0in 5.4pt 0in 5.4pt;
mso-para-margin-top:0in;
mso-para-margin-right:0in;
mso-para-margin-bottom:8.0pt;
mso-para-margin-left:0in;
line-height:107%;
mso-pagination:widow-orphan;
font-size:11.0pt;
font-family:"Calibri","sans-serif";
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;
mso-bidi-font-family:"Times New Roman";
mso-bidi-theme-font:minor-bidi;}
ASA House of Delegates. ASA physical status classifi-cation system. 2014.
Carroll K, Majeed A, Firth C, Gray J. Prevalence and management of coronary heart disease in primary care: population-based cross-sectional study using a disease register. J Public Health Med 2003;25(1):29-35. [CrossRef] [PubMed]
Davenport DL, Ferraris VA, Hosokawa P, Henderson WG, Khuri SF, Mentzer Jr RM. Multivariable predictors of postoperative cardiac adverse events after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007;204:1199-210. [CrossRef] [PubMed]
Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC ⁄ AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Sum-mary: A Report of the American College of Cardiology⁄ American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Inter-ventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 2007; 116:1971-96. [CrossRef] [PubMed]
Golubovic M, Peric V, Stanojevic D, Lazarevic M, Jovanovic N, Ilic N, et al. Potential New Approaches in Predicting Adverse Cardiac Events One Month After Major Vascular Surgery. Med Princ Prac 2019;28(1): 63-9. [CrossRef] [PubMed]
Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation 2011;124:381-7. [CrossRef] [PubMed]
Jujo K, Minami Y, Haruki S, Matsue Y, Shimazaki K, Kadowaki H, et al. Persistent high blood urea nitrogen level is associated with increased risk of cardiovascular events in patients with acute heart failure. ESC Heart Fail 2017;4(4):545-53. [CrossRef] [PubMed]
Knotzer H, Filipovic M, Siegemund M, Kleinsasser A. The physiologic perspective in fluid management in vascular anesthesiology. J Cardiothorac Vasc Anesth 2014;28(6):1604-8. [CrossRef] [PubMed]
Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur J Anaesthesiol 2014;31(10):517-73. [CrossRef] [PubMed]
Mangano DT. Peri-operative medicine: NHLBI working group deliberations and recommendations. J Cardio-thorac Vasc Anesth 2004;18:1-6. [CrossRef] [PubMed]
Ngobeni TN. Risk stratification for non-cardiac surgery. South Afr J of Anaesthand Analg 2018;24(3):6-12.
Ren X, Qu W, Zhang L, Liu M, Gao X, Gao Y, et al. Role of blood urea nitrogen in predicting the post-discharge prognosis in elderly patients with acute decompensated heart failure. Sci Rep 2018;8(1): 13507. [CrossRef] [PubMed]
The Criteria Committee of the New York Heart Asso-ciation. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston: Little, Brown & Co; Boston, Mass: 1994. p. 253-6.