Perioperative myocardial ischemia in coronary artery disease patients undergoing abdominal nonvascular surgery

Abstract

Background: The incidence of perioperative myocardial ischemia (PMI) is the highest in patients who have coronary artery disease, and it is the best predictor of intrahospital morbidity and mortality.

Objective: To identify predictors of PMI in patients who have coronary artery disease and are undergoing abdominal nonvascular surgery.

Methods: A prospective, observational, clinical study of 111 consecutive patients with angiographically verified coronary artery disease, scheduled for open abdominal nonvascular surgery, was conducted. Patients received general anesthesia and were monitored by continuous electrocardiogram during surgery and immediately postsurgery (72 h period) in the intensive care unit at the University Clinical Center (Belgrade, Serbia). All of the patients had 12-lead electrocardiography immediately after the surgery, on postoperative days 1, 2 and 7, and one day before discharge from hospital. The patients were monitored until the 30th postoperative day.

Results: A total of 24 predictors for PMI were analyzed. The Pearson's chi(2) test and a binomial logistic regression model were used for statistical analysis. A significant difference in the incidence of PMI was found in the coronary artery disease patients with an associated risk factor (14 of 24 risk factors) compared with those without the risk factor. In particular, a highly significant difference in the incidence of PMI was found in coronary artery disease patients with angina pectoris, compared with those without angina pectoris.

Conclusion: Using the multivariate logistic regression analysis, angina pectoris was an independent predictor of PMI.

Keywords: Beta-blockers; Cardioprotection; Coronary ischemia; Metoprolol; Surgery.