Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000400007
Brazilian Journal of Anesthesiology
Clinical Information

Incidência de isquemia miocárdica no pós-operatório de pacientes submetidos à cirurgia para correção de aneurisma de aorta abdominal: estudo retrospectivo

Postoperative myocardial ischemia in patients undergoing abdominal aortic aneurysm repair: a retrospective study

Domingos Dias Cicarelli; Cristina Keiko Marumo; Ricardo Gonçalves Esteves

http://dx.doi.org/10.1590/S0034-70942001000400007 Braz J Anesthesiol, vol.51, n4, p.319-324, 2001
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Resumo

JUSTIFICATIVA E OBJETIVOS: Muitos pacientes submetidos à cirurgia para correção de aneurisma de aorta abdominal apresentam doença coronariana, podendo evoluir com complicações cardíacas perioperatórias. A grande dificuldade é avaliar, no pré-operatório, o risco de complicações cardíacas isquêmicas que ocorrem no período pós-operatório de modo confiável. O objetivo deste estudo foi verificar a incidência de isquemia cardíaca pós-operatória em pacientes submetidos à correção de aneurisma da aorta abdominal, sua correlação com o índice de risco cardíaco de Goldman modificado, com alterações no teste do tálio-dipiridamol e os fatores de risco nessa população. MÉTODO: Foram analisados retrospectivamente 65 pacientes submetidos à correção de aneurisma da aorta abdominal e a incidência dos fatores de risco como tabagismo, insuficiência coronariana, hipertensão arterial sistêmica e Diabetes mellitus. Foi analisada a correlação entre a insuficiência coronariana no pré-operatório, o índice de Goldman modificado e as complicações isquêmicas pós-operatórias. Foi avaliada a correlação do teste tálio-dipiridamol pré-operatório e eventos isquêmicos no pós-operatório. RESULTADOS: Cerca de 80% dos pacientes apresentavam antecedente de tabagismo, 55% de hipertensão arterial, 8% de Diabetes mellitus, 25% de insuficiência coronariana. Entre os pacientes com insuficiência coronariana, cinco possuíam angina pré-operatória e apresentaram uma incidência de 40% de isquemia miocárdica no pós-operatório, sendo a incidência de infarto agudo do miocárdio de 6,2%. No nosso estudo, 14% dos pacientes Goldman modificado II e 33% dos pacientes Goldman modificado III apresentaram isquemia miocárdica pós-operatória. Dezesseis pacientes (24%) foram submetidos ao tálio dipiridamol no pré-operatório, sendo que 10 (62%) apresentaram defeitos de captação cintilográfica. O valor preditivo positivo do exame foi de 20% para isquemia miocárdica pós-operatória, com valor preditivo negativo de 83% e sensibilidade de 66%. CONCLUSÕES: A incidência de complicações cardíacas de acordo com o índice de Goldman modificado não foi compatível com o risco teórico desse índice. Os pacientes com angina no período pré-operatório apresentaram alta porcentagem (40%) de isquemia no pós-operatório, sendo que o valor do tálio-dipiridamol como teste preditivo de complicações isquêmicas foi baixo.

Palavras-chave

CIRURGIA, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Many patients undergoing abdominal aortic aneurysm repair are at high risk for perioperative myocardial ischemia. The great difficulty is to reliably evaluate the preoperative risk of postoperative myocardial ischemia. This study aimed at observing the incidence of postoperative myocardial ischemia in patients submitted to abdominal aortic aneurysm repair, its correlation with Goldman’s modified cardiac risk index, with changes in the dipyridamole-thallium test and the risk factors for such population. METHODS: Participated in this retrospective study 65 patients submitted to abdominal aortic aneurysm repair. Risk factors, such as smoking, coronary artery disease, systemic hypertension and diabetes mellitus, were evaluated as well as the correlation among preoperative coronary artery disease, Goldman’s modified cardiac index risk and postoperative myocardial ischemia. The correlation between preoperative dipyridamole-thallium test and postoperative cardiac complications was also evaluated. RESULTS: Approximately 80% of patients were smokers, 55% were hypertensive, 8% had diabetes mellitus and 25% of patients presented with coronary artery disease. Among coronary artery disease patients, five patients had preoperative angina with an incidence of 40% of postoperative myocardial ischemia and 6.2% of myocardial infarction. In our study, 14% of Goldman’s modified II and 33% of Goldman’s modified III had postoperative myocardial ischemia. Sixteen patients (24%) were submitted to preoperative dipyridamole- thallium test and 10 patients (62%) presented reperfusion defects. Positive dipyridamole-thallium test predictive value was 20% for postoperative myocardial ischemia with a negative predictive value of 83% and sensitivity of 66%. CONCLUSIONS: The incidence of cardiac complications as predicted by Goldman’s modified index was not compatible with the theoretical risk of such index. Patients with preoperative angina had a high percentage (40%) of postoperative ischemia and dypiramidole-thalium test had a low ischemia-predicting value.

Keywords

COMPLICATIONS, SURGERY

References

Fleisher LA, Rosenbaum SH, Nelson AH. Preoperative dipyridamole thallium imaging and ambulatory electrocardiographic monitoring as a predictor of perioperative cardiac events and long term outcome. Anesthesiology. 1995;83:906-917.

Goldman L, Caldera DL, Nussbaum SR. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845-850.

Detsky A, Abrams H, McLaughlin J. Predicting cardiac complications in patients undergoing noncardiac surgery. J Gen Intern Med. 1986;1:211-219.

Fleisher LA. Preoperative assessment of the patient with cardiovascular disease. Anais da Jornada Paulista de Anestesiologia. 1999;33:15-19.

Eagle KA, Coley CM, Newell JB. Combining clinical and thallium optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med. 1989;110:859- 866.

Executive summary of the ACC/AHA task force report: guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Anesth Analg. 1996;82:854-860.

Edwards ND, Reilly CS. Detection of perioperative myocardial ischemia. Br J Anaesth. 1994;72:104-115.

Baron JF, Mundler O, Bertrand M. Dipyridamole - thallium scintigraphy and gated radionuclide angiography to assess cardiac risk before abdominal aortic surgery. N Engl J Med. 1994;330:663-669.

Mangano DT, Browner WS, Hollenberg M. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med. 1990;323:1781-1788.

Fleisher LA. Perioperative management of the cardiac patient undergoing noncardiac surgery. Annual Refresher Course Lectures - ASA. 1995;23:221.

Boucher CA, Brewster DC, Darling RC. Determination of cardiac risk by dipyridamole thallium imaging before peripheral vascular surgery. N Engl J Med. 1985;312:389-394.

Mangano DT, London MJ, Tubau JF. Dipyridamole thallium - 201 scintigraphy as a preoperative screening test: A re-examination of its predictive potential. Circulation. 1991;84:493-502.

McEnroe CS, O’Donnel T, Yeager A. Comparison of ejection fraction and Goldman risk factor analysis to dipyridamole- thallium 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery. J Vasc Surg. 1990;11:497-504.

Marwick TH, Underwood DA. Dipyridamole thallium imaging may not be a reliable screening test for coronary artery disease in patients undergoing vascular surgery. Clin Cardiol. 1990;13:14-18.

Landesberg G, Einav S, Christopherson R. Perioperative ischemia and cardiac complications in major vascular surgery: Importance of the preoperative twelve lead electrocardiogram. J Vasc Surg. 1997;26:570-578.

Sprung J, Abdelmalak B, Gottlieb A. Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery. Anesthesiology. 2000;93:129-140.

Fleisher LA, Nelson AH, Rosenbaum SH. Failure of negative dipyridamole thallium scans to predict perioperative myocardial ischaemia and infarction. Can J Anaesth. 1992;39:179-183.

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