Incidence of perioperative myocardial infarction and cardiac death after vascular surgery

Surgery Type Categories

Total

N

Incidence of MI

Mortality

Carotid endarterectomy (total)

2,437

34/2,437 = 1.4%

2/2,437 = 0.08%

  • Internal carotid endarterectomy

2,349

   
  • External carotid endarterectomy

17

   
  • Carotid-subclavian graft

66

   
  • Carotid-carotid graft

5

   

Aortic surgery prosthetic grafts (total)

1,934

37/1,934 = 1.91%

10/1,934 = 0.52%

Thoracic (total)

332

4/332 = 1.2%

3/332 = 0.9%

  • Thoraco-abdominal aneurysm repair

139

   
  • Aorto-celiac graft*

16

   
  • Aorto-mesenteric graft

88

   
  • Suprarenal

89

   

Abdominal (total)

1,602

33/1,602 = 2.06%

7/1,602 = 0.44%

Aorto-bi-iliac

1,300

   

Aorto-bi-femoral

244

   

Aorto-iliac - aorto-femoral

58

   

Peripheral vascular surgery (total)

2,577

36/2,577 = 1.4%

10/2,577 = 0.4%

Peripheral vascular reconstructive surgery (total)

1,246

30/1,246=2.4%

6/1,246 = 0.48%

  • Ilio-femoral graft

119

   
  • Femoral-femoral graft

180

   
  • Profundoplasty

61

   
  • Femoral-popliteal graft

439

   
  • Femoral-tibial graft (anterior and posterior)

270

   
  • Femoral-peroneal graft

177

   

Amputations (total)

1,331

6/1,331 = 0.45%

4/1,331 =0.30%

  • Toe

332

   
  • Transmetatarsal

267

   
  • Leg below the knee

477

   
  • Leg above the knee

255

   

Total

6,948

107/6,948 = 1.54%

22/6,948 = 0.31%

*Performed as primary procedure, not as a part of thoraco-abdominal aneurysm repair; Includes procedures performed for reconstruction of either superior (n=48) or inferior (n=40) mesenteric arteries.

Summary of causes of death in patients who suffered perioperative myocardial infarction and in control group

Pt

Age/Sex

Surgery

POD-MI

POD Death

Cause of Death*

PMI group

 

63/M

AARS

0

1

Massive blood loss, hyperkalemia, severe hypotension

 

74/F

PVS

5

5

Cardiogenic shock, dysrhythmia (ventricular)

 

72/M

PVS

1

11

Cardiogenic shock

 

84/F

PVS

1

3

Cardiogenic shock followed by asystole

79/M

PVS

0

0

Hemodynamic instability, ventricular dysrhythmia, ventricular fibrillation

 

65/M

AARS

0

1

Acute severe hypotension, cardiogenic shock, asystole

 

69/M

TARS

0

1

Acute severe hypotension, cardiogenic shock

 

80/F

PVS

1

2

Postoperative acute myocardial ischemia, cardiac arrest during unsuccessful PTCA

 

72/M

AARS

0

0

Hypotension, ventricular fibrillation

 

77/F

PVS

0

38

Dysrhythmia, CHF, MSOF

 

69/M

TARS

0

1

Acute intraoperative hypotension, ECG c/w acute MI, postoperatively ARDS, ARF

 

82/M

AARS

1

3

Acute hypotension requiring vasopressor support, ARDS

 

72/M

PVS

1

33

Cardiogenic shock

 

84/F

PVS

1

1

Cardiogenic shock

 

68/M

CEA

1

5

Hypotension requiring vasoactive support

 

68/M

AARS

1

18

Ventricular dysrhythmia, ARF, septic shock, gastrointestinal bleeding

 

70/M

AARS

0

24

Intraoperative MI, urgent partially successful PTCA, postoperatively long-term mechanical (IABP) and vasopressor support, ARF, gastrointestinal bleeding

 

72/M

PVS

3

3

Autopsy confirmed massive acute MI

 

77/M

CEA

1

39

Cardiac dysrhythmia, severe hypotension, cardiac arrest

 

73/M

TARS

0

2

Ventricular tachycardia, cardiogenic shock, asystole

85/M

PVS

2

30

CHF after MI, long-term vasoactive support, sepsis

76/M

AARS

1

45

Ventricular dysrhythmia, MSOF

Control Group

75/F

CEA

---

8

Sudden asystole without evidence of acute MI

64/M

AARS

---

77

ARDS, wound dehiscence (steroid dependence for COPD), septicemia, ARF

74/M

TARS

---

8

ARSD, celullitis/fasciitis, sepsis, acute hemorrhage, shock

73/F

PVS

---

19

ARF, acidosis, CHF (no evidence of MI)

*Description is based on terminology used in physicians' notes. F, female; M, male; Age (in years); POD-MI, postoperative day when myocardial infarction was diagnosed; MSOF, multisystem organ failure; CHF, congestive heart failure; IABP, intraaortic balloon pump, ARDS, adult respiratory distress syndrome; ARF, acute renal failure; PTCA, percutaneous transluminal coronary angioplasty; AARS abdominal aortic reconstructive surgery; TARS, thoracic aortic reconstructive surgery; PVS, peripheral vascular surgery.