Document Detail

Myocardial ischemia revisited.
MedLine Citation:
PMID:  16810014     Owner:  NLM     Status:  MEDLINE    
Does perioperative myocardial ischemia lead to postoperative myocardial infarction? By Stephen Slogoff and Arthur S. Keats. Anesthesiology 1985; 62:107-14. Reprinted with permission. To determine if a relationship exists between perioperative myocardial ischemia (ST segment depression greater than or equal to 0.1 mV) and postoperative myocardial infarction (PMI), nonparticipating observers recorded all electrocardiographic, hemodynamic, and other events between arrival of patients in the operating room and onset of cardiopulmonary bypass during 1,023 elective coronary artery bypass operations (CABG). The roles of preoperative patient characteristics, quality of the operation limited by disease as rated by the surgeon and duration of ischemic cardiac arrest as risk factors for PMI also were quantified. Electrocardiographic ischemia occurred in 36.9% of all patients, with almost half the episodes occurring before induction of anesthesia. PMI was almost three times as frequent in patients with ischemia (6.9% vs. 2.5%) and was independent of when ischemia occurred. Ischemia was related significantly to tachycardia but not hypertension nor hypotension and was frequent in the absence of any hemodynamic abnormalities. The anesthesiologist whose patients had the highest rate of tachycardia and ischemia had the highest rate of PMI. Although neither single nor multiple preoperative patient characteristics related to PMI, suboptimal quality of operation and prolonged ischemic cardiac arrest increased the likelihood of PMI independent of the occurrence of myocardial ischemia. The authors conclude that perioperative myocardial ischemia is common in patients undergoing CABG, occurs randomly as well as in response to hemodynamic abnormalities, and is one of three independent risk factors the authors identified as related to PMI. PMI is unrelated to preoperative patient characteristics such as ejection fraction and left main coronary artery disease, and its frequency will relate primarily to perioperative management rather than patient selection.
Stephen Slogoff; Arthur S Keats
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Anesthesiology     Volume:  105     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-06-30     Completed Date:  2006-08-11     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  214-6     Citation Subset:  AIM; IM    
Department of Anesthesiology, Stritch School of Medicine, Loyola University Chicago, Illinois 60153, USA.
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MeSH Terms
Myocardial Infarction / epidemiology,  etiology
Myocardial Ischemia / complications,  epidemiology*
Perioperative Care / adverse effects
Postoperative Complications / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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