The Perioperative Cardiac Risk Assessment And Analyses In Elderly Patients With Coronary Artery Disease Underwent Major Noncardiac Surgery

BACKGROUND:Coronary artery disease(CAD) is one of the most common disease in the elderly.It can induce and aggravate various cardiac events for the elderly patients who underwent major noncardiac surgery.Perioperative cardiac events are the leading cause of morbidity and mortality in the patients undergoing elective surgery. So how to assess the patient's perioperative cardiac risk and how to protect the patient's safety in the perioperative period are the hot questions for many clinicians.Now there are some related studies in this field.But few data can be obtained for the elderly patients with CAD at present time. OBJECTiVE :In order to report the multifactorial cardiac risk index and investigate the characteristics of perioperative myocardial ischemia,myocardial infarction,heart failure and death for the elderly patients with CAD who underwent noncardiac surgery through retrospectively analyzing the medical history. CLINICAL DATA AND METHODS:The clinical consecutive medical records of 422 eldlerly patients with CAD who underwent noncardiac surgery were selected . Some related parameters of the patients in preoperative intraoperative and postoperative were registered.We retrospectively analyzed the data of perioperative myocai-dial ischemia,myocardial infarction,heart failure,death and get the multifactorial cardiac risk index by stepwise logistic regression analyses. RESULT:1.We indentified seven independent risk factors to correlate with perioperative cardiac events:preoperative myocardial infarction,unstable angia pectoris,heart failure,cerebral stroke,ST segment depressed≥O. O5mv, HB＜120g/l, WBC>1.O × 10~9/L.Patients could be separated into four classes of significantly different risk.In the progression from risk class I to risk class LV ,there were a statistically significant stepwise elevate in the morbidity of cardiac events.In terms of cardiac death,the mortality elevated with the progression of the risk class,but there were statistically signigicant different only between class I and classlV,class IL and class LV .2.The incidence of perioperative ischemia was 27.18%, 9.9 1% for intraopeartive and 22.84% for postoperative(p=0.0001).Among of 94 cases of postoperative ischemia,88.6% occurred during the first three days after surgety, 18.05% accompanied angia pectoris,8 1.95% was asymptomatic.We identified preoperative myocardial infarction,heart failure and ST segment depressed~0.05mv were the independent risk factors for the postopeartive ischemia.3.Ten of 4l2patients(2.43%) had postopeartive myocardial infarction,all of them happened in the postoperative and 70% occurred within the first week afler surgery.Only 3 of 10 had chest pain,6O% of them were non-Q wave myocardial infarction. Preoperative unstable angia pectoris,heart failure,ST segment depressed ~ 0.OSmv and postoperative myocardial ischemia were related to periopeartive myocardial infarction.4.Twenty-six of 412 patients(6.55%) developed postopeartive heart dysfunction,57.69% of them happened during the first three days after surgery.The main predisposing factors as follow:of which 4 were myocardial infarction and pulmonary infection respectively, 10 were elevation of heart rate and blood pressure. 5 were fluid shift. Preoperative myocardial infarction, unstable angia pectoris,heart failure,ST segment depressed ~0.05mv and postoperative myocardial ischemia were related to periopeartive heart failure.5.Eighteen patients died during periopeartive time, of which 6 1.11% died from cardiac events and...