Retrospective analysis of 20 cases of perioperative myocardial infarction after non-cardiac surgery

ZHAO Jian; LI Na; JI Jie; LIANG Chun

doi:10.3969/j.issn.1671-6450.2018.04.004

Abstract：Objective To investigate the risk factors,treatment modalities and prognosis of perioperative myocardial infarction (PMI) after non-cardiac surgery and provide clinical experience for prevention and treatment of this complication. Methods Retrospectively collected clinical data including medical history,laboratory test results,ECG,operation,treatment and prognosis of patients complicating PMI after non-cardiac surgery between January 2014 and December 2016 in Shanghai Changzheng Hospital. Those patients without PMI during the duration were selected as controls at a ratio of 1:10.Results A total of 20 cases of PMI were identified. Compared with control group,the proportion of elder patients(age>60),the preva-lence of hypertension,coronary heart disease,diabetes and renal insufficiency(eGFR<60 ml/min),the rate of preoperative ST-T segment change on ECG and white blood cell,CRP levels in PMI group were significantly higher(P<0.05);red blood cells count in PMI group were significantly lower than that in the control group (P<0.05). Multiple Logistic regressions showed that leukocyte level and preoperative ST-T segment change on ECG were independent risk factors for PMI. ST segment elevation myocardial infarction and acute heart failure or cardiogenic shock were positively correlated with mortality of PMI (r=0.471,P =0.036), but percutaneous coronary intervention (PCI) was negatively correlated (r = -0.707, P =0.000). Conclusion Multiple factors are associated with PMI after non-cardiac surgery,in which leukocyte level preopera-tive ST T segment change on ECG are independent risk factors of PMI. Once PMI occurs,the mortality rate is high and timely and effective interventional therapy can improve the prognosis.