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The Incidence of Perioperative Myocardial Infarction in Men Undergoing Noncardiac Surgery

Carol M. Ashton, MD, MPH; Nancy J. Petersen, MS; Nelda P. Wray, MD, MPH; Catarina I. Kiefe, PhD, MD; J. Kay Dunn, PhD; Louis Wu, PA-C; and JoAnn M. Thomas, BS
[+] Article, Author, and Disclosure Information

From the Veterans Affairs Medical Center, Houston, Texas. Requests for Reprints: Carol Ashton, MD, MPH, Veterans Affairs Medical Center (111), 2002 Holcombe Boulevard, Houston, TX 77030. Acknowledgments: The authors thank Drs. James Alexander and Gene Guinn for their advice and encouragement. Grant Support: By the American Heart Association, Texas Affiliate (87G-173) and the Center for Quality of Care and Utilization Studies: a Veterans Affairs Health Services Research and Development Field Program.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(7):504-510. doi:10.7326/0003-4819-118-7-199304010-00004
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Objectives: To determine the incidence of and risk factors for perioperative myocardial infarction with noncardiac surgery and to test the accuracy of a risk stratification system.

Design: Prospective cohort study.

Setting: A large urban Veterans Affairs hospital.

Participants: A total of 1487 men older than 40 years undergoing major, nonemergent, noncardiac operations.

Measurements: Infarction was established by at least two of the following: development of new Q waves, typical change in creatine kinase MB, and positive technetium pyrophosphate scintigraphy. Patients were stratified preoperatively into high-, intermediate-, low-, and negligible-risk strata based on clinical markers corresponding to different levels of coronary artery disease prevalence.

Main Results: Patients with coronary disease (high-risk stratum) had a 4.1% incidence of infarction (13 of 319; 95% CI, 1.8% to 6.4%); patients with peripheral vascular disease but no evidence of coronary disease (intermediate-risk stratum) had a 0.8% incidence (2 of 260, upper bound of CI, 2.0%); patients with high atherogenic risk factor profiles but no clinical atherosclerosis (low-risk stratum) had a 0% incidence (0 of 256, upper bound of CI, 1.2%). No cardiac deaths occurred in 652 men who had no atherosclerosis and low atherogenic risk factor profiles (the negligible-risk stratum). Factors independently associated with infarction included age more than 75 years (adjusted odds ratio, 4.77; CI, 1.17 to 19.41), signs of heart failure on the preoperative examination (adjusted odds ratio, 3.31; CI, 0.96 to 11.38), coronary disease (adjusted odds ratio, 10.39; CI, 2.27 to 47.46), and a planned vascular operation (adjusted odds ratio, 3.72; CI, 1.12 to 12.37).

Conclusions: Coronary artery disease is the major risk factor for perioperative infarction. The stratification scheme identifies subsets of patients with different risks, and finer within-stratum distinctions can be made using additional variables.


Grahic Jump Location
Figure 1.
Study population.

Chart review patients are patients who declined to undergo a structured preoperative evaluation and postoperative testing for infarction or who were missed by the study team.

Grahic Jump Location




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