The Incidence of Perioperative Myocardial Infarction in Men Undergoing Noncardiac Surgery

作者：Carol M. Ashton, Nancy J. Petersen, Nelda P. Wray, Catarina I. Kiefe, J. Kay Dunn, Louis Wu, JoAnn M. Thomas · 发表于：Annals of Internal Medicine · 年份：1993 · DOI：10.7326/0003-4819-118-7-199304010-00004 · 被引用次数：354 · 研究领域：Cardiac, Anesthesia and Surgical Outcomes、Acute Myocardial Infarction Research、Cardiac Valve Diseases and Treatments

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 he...