Frequency of Concomitant Cardiac Disease and Postoperative Cardiac Events in the Patients Underwent Elective Arterial Surgery: with Reference to Ischemic Heart Disease (IHD)

ABSTRACT

PURPOSE: Cardiac disease has been known as the most common cause of early and late postoperative mortality following elective arterial surgery. We attempted to investigate the prevalence of concomitant cardiac disease and predictor of postoperative cardiac events in the patients undergoing elective arterial surgery. METHOD: We retrospectively reviewed 300 patients who underwent elective arterial operations at the Department of Surgery, Kyungpook National University Hospital. For preoperative cardiac screening, history taking and physical examination were done with ECG and CK-MB enzyme (OPUS CK-MB, Behring Diagnostic) measurement. Transthoracic echocardiography (145), myocardial perfusion scanning (81, adenosine Tc-99m MIBI or thallium-201 SPECT), and coronary angiography (5) were performed in selective basis. IHD was defined by perfusion defect on myocardial scan and clinical criteria consisting of chest pain, ECG abnormality and serum CK-MB>5%. Possible risk factors including age(> or= 70 years), previous cardiac symptom, aortic clamping, abnormal cardiac function tests, and comorbidities were analyzed to determine the predictor of cardiac events after arterial surgery. RESULT: IHD was associated with in 20.2% of the patients with chronic arterial occlusive disease and 12.8% of patients with abdominal aortic aneurysm. IHD were more commonly associated with diabetes (30.3% vs 15.8%, p=0.014) and hypertension (28.2% vs 11.8%, p=0.0003). After 340 arterial operations for 300 patients, 11 (3.7%) cardiac events (1 congestive heart failure, 10 myocardial infarction or anginal attack and 1 cardiac deaths) were followed. By univariate statistical analysis, postoperative cardiac events occurred more frequently in the patients with prior history of cardiac symptom (9.5% vs 2.7%, p=0.052) and higher CK-MB titer (11.8% vs 3.0%, p=0.038). CONCLUSION: In determining the indications for more detailed preoperative cardiac evaluation, presence of diabetes or hypertension should be considered. To reduce the risk of postoperative cardiac events after elective arterial surgery, more intensive cardiac monitoring is required for the patients with previous cardiac symptoms and/or elevated serum CK-MB.