Identification and treatment of myocardial ischemia in patients undergoing peripheral vascular surgery

T. C. Andrews, L. Goldman, M. A. Creager, M. C. Donaldson, A. D. Whittemore, J. Barry, E. F. Cook, A. P. Selwyn, K. E. Raby

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11 Scopus citations

Abstract

Patients who have myocardial ischemia on preoperative Holter monitoring have a high risk of postoperative cardiac events after peripheral vascular surgery. We have previously reported that of 41 patients with preoperative ischemia whose clinicians were blinded to Holter results, 17 (42%) suffered cardiac events including three deaths and six myocardial infarctions. Using these data as historical controls, we determined whether unblinding clinicians to Holter results decreases risk. We screened 145 patients undergoing elective peripheral vascular surgery with preoperative Holter monitoring. Clinicians were notified of the Holter monitor results and treated patients perioperatively as they felt appropriate. Patients were followed to hospital discharge and a blinded expert determined the occurrence of cardiac events. Thirty-six patients had at least one episode of preoperative ischemia, and six (17%) had postoperative cardiac events, including no deaths and one myocardial infarction, a 2.5-fold reduction in risk when compared with historical controls (95% confidence interval 1.1-5). These 36 patients had up to 48 hours of postoperative Holter monitoring, and 22 had 120 minutes or less of ischemia per day with no adverse events, while 14 had more than 120 minutes of ischemia per day with six adverse events (p = .001). Compared with historical controls, patients prospectively identified with preoperative ischemia had a lower overall rate of adverse cardiac events postoperatively, with all events occurring in patients who had more than 120 minutes of postoperative ischemia per day. These data justify a randomized trial to examine the role of medical therapy in reducing postoperative ischemia and cardiac events.

Original languageEnglish (US)
Pages (from-to)8-15
Number of pages8
JournalJournal of Vascular Medicine and Biology
Volume5
Issue number1-2
StatePublished - Oct 19 1994

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Keywords

  • Holter monitoring
  • myocardial ischemia
  • peripheral vascular surgery
  • preoperative identification of ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Andrews, T. C., Goldman, L., Creager, M. A., Donaldson, M. C., Whittemore, A. D., Barry, J., Cook, E. F., Selwyn, A. P., & Raby, K. E. (1994). Identification and treatment of myocardial ischemia in patients undergoing peripheral vascular surgery. Journal of Vascular Medicine and Biology, 5(1-2), 8-15.