Perioperative Cardiac Damage in Vascular Surgery Patients

• Published in: European journal of vascular and endovascular surgery Vol. 40; no. 1; pp. 1 - 8
• Main Authors: Flu, W.-J, Schouten, O, van Kuijk, J.-P, Poldermans, D
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2010
• Subjects: Asymptomatic myocardial damage; Biomarkers - blood; Early Diagnosis; Humans; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial Infarction - metabolism; Myocardial Infarction - mortality; Myocardial Infarction - pathology; Myocardial Infarction - prevention & control; Myocardial Ischemia - diagnosis; Myocardial Ischemia - etiology; Myocardial Ischemia - metabolism; Myocardial Ischemia - mortality; Myocardial Ischemia - pathology; Myocardial Ischemia - prevention & control; Myocardium - metabolism; Myocardium - pathology; Predictive Value of Tests; Prevalence; Prognosis; Risk Assessment; Risk Factors; Surgery; Troponin I - blood; Troponin T - blood; Vascular surgery; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Vascular surgery; Asymptomatic myocardial damage
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2010.03.014

Abstract Background Patients undergoing vascular surgery are at increased risk for developing cardiac complications. Majority of patients with perioperative myocardial damage are asymptomatic. Our objective is to review the available literature addressing the prevalence and prognostic implications of perioperative myocardial damage in vascular surgery patients. Methods An Internet-based literature search was performed using MEDLINE to identify all published reports on perioperative myocardial damage in vascular surgery patients. Only those studies published from 2000 to 2010 evaluating myocardial damage using troponin I or T, with or without symptoms of angina pectoris were included. Results Thirteen studies evaluating the prevalence of perioperative myocardial ischaemia or infarction were included in the study. The incidence of perioperative myocardial ischaemia ranged from 14% to 47% and the incidence of perioperative myocardial infarction ranged from 1% to 26%. In addition, 10 studies evaluating the prognostic value of perioperative myocardial ischaemia towards postoperative mortality or the occurrence of major adverse cardiac events were included. In the retrieved studies, hazard ratios varied from 1.9 to 9.0. Conclusion The high prevalence and asymptomatic nature of perioperative myocardial damage, combined with a substantial influence on postoperative mortality of vascular surgery patients, underline the importance of early detection and adequate management of perioperative myocardial damage. This article provides an extended overview regarding the prevalence and prognostic value of perioperative myocardial ischaemia and infarction in vascular surgery patients. In addition, treatment options to reduce the risk of perioperative myocardial damage are provided based on the current available literature.