| 471855 - perioperative myocardial ischemia in isolated systolic hypertension(promise): a preliminary report. | |
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MedLine Citation:
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PMID: 18753504 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Introduction: Isolated Systolic Hypertension (ISH) is increasingly recognized as a cardiovascular risk1. It is associated with aging and accounts for 65% of uncontrolled hypertension. The WHO reports that suboptimal BP (> 115 mm Hg SBP) is responsible for 62% of cerebrovascular disease and 49% of ischemic heart disease. The relationship between ISH and perioperative cardiac complications is poorly understood. We hypothesized that ISH surgical patients would have a higher incidence of perioperative myocardial ischemia and hence potentially a higher risk for myocardial infarction and cardiac death. METHODS: The primary objective is to determine if the incidence of perioperative myocardial ischemia in ISH patients is triple that of normotensive patients admitted for non-cardiac surgery, as determined by 48-hour ambulatory ST segment ECG (AECG). The sample size was calculated to be 360 patients with 180 patients being an ISH. Inclusion criteria are: age >/= 45 years; elective non cardiac surgical procedure; expected hospital stay >/= 48 hours; Revised Cardiac Risk Index (RCRI) </= 2. Exclusion criteria are: a fibrillation; LBBB; MI < 3 months; unstable coronary syndrome; dialysis. Ischemia is defined as reversible ST depressions </= 1 mm measured at 60 msec from the J point or ST elevations >/= 2 mm at the J point lasting longer than one minute. After REB approval, to date recruitment resulted in 164 patients. RESULTS: The preliminary results of 164 patients demonstrated a mean age of 65+10; male:female 77:87; RCRI 1:2 148(90.2%):16(9.8%). The overall incidence of myocardial ischemia is 21.3%.Discussion: As preliminary results, the prevalence of the perioperative ISH is unknown. However, the overall myocardial ischemia incidence of 21.3% is high for 48 hours of AECG monitoring in patients with RCRI </= 2. A database study of over 700,000 patients showed that of the total mortality, 8,443 were from RCRI </= 2 patients; only 2,338 were from RCRI Class >/= 3. The bulk of the mortality is in the "low risk" patients2. With these preliminary results, we feel that ISH "low risk" patients may be the forgotten patients. |
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Authors:
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Ashraf Fayad; Homer Yang; Terry Ruddy; Jim Watters; George Wells |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Canadian journal of anaesthesia = Journal canadien d'anesthésie Volume: 55 Suppl 1 ISSN: 0832-610X ISO Abbreviation: - Publication Date: 2008 Jun |
Date Detail:
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Created Date: 2008-08-28 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8701709 Medline TA: Can J Anaesth Country: Canada |
Other Details:
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Languages: eng Pagination: 471855 Citation Subset: IM |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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