Document Detail


471855 - perioperative myocardial ischemia in isolated systolic hypertension(promise): a preliminary report.
MedLine Citation:
PMID:  18753504     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Ashraf Fayad; Homer Yang; Terry Ruddy; Jim Watters; George Wells
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthésie     Volume:  55 Suppl 1     ISSN:  0832-610X     ISO Abbreviation:  -     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-08-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  471855     Citation Subset:  IM    
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