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Dovzhanskiy DI, Bischoff MS, Jäckel P, Boeckler D. [Diagnosis and Management of Perioperative Myocardial Ischemia after Elective Aortic Aneurysm Surgery]. Zentralbl Chir 2024; 149:391-397. [PMID: 35915925 DOI: 10.1055/a-1880-1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Perioperative myocardial ischemia (PMI) is a serious postoperative complication. Aortic operations represent an especially high-risk surgery concerning cardiac complications. This aim of this study was to analyse the clinical features of PMI after elective aortic aneurysm surgery. PATIENTS AND METHODS This study is a retrospective analysis of 863 patients who underwent elective aortic aneurysm surgery between 2005 and 2012 in the Department of Vascular and Endovascular Surgery of Heidelberg University Hospital with regard to PMI. The PMI diagnosis was based on a positive serum troponin diagnostic test. We evaluated the clinical course, time point of the diagnosis and features of diagnostics to characterise PMI. Moreover, we analysed the treatment options and management of the patients' discharge. RESULTS Thirty-one patients (3.6% of 863) with PMI after elective aortic aneurysm surgery were identified. Of these, 21 patients (67.7%) underwent open surgery and 10 patients (32.3%) received endovascular treatment. PMI was diagnosed in 24 patients (77%) during the first 3 days. More than half of these patients (16/31) were clinically asymptomatic. Electrocardiogram did not show pathological findings in 24 cases (77.4%). The first troponin measurement was not elevated in eight patients (25.8%). Drug therapy alone was used in 17 cases (54.8%) of PMI, coronary catheterisation was performed in 12 patients (38.7%) and two patients (6.5%) received aortocoronary bypass. Fourteen patients (45.1%) were discharged home and another 14 patients (44.1%) were transferred to another hospital or to a rehabilitation institution. Two patients died because of multi-organ failure. CONCLUSION PMI is not a rare complication after elective aortic surgery. The diagnosis of PMI can be challenging because of occult symptoms especially in a perioperative setting. Due to the potentially serious consequences, cardiac enzyme diagnostics should be initiated immediately if there is suspicion of PMI or routinely in defined at-risk patients after aortic surgery.
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Affiliation(s)
- Dmitriy I Dovzhanskiy
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - Moritz S Bischoff
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - Petra Jäckel
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - Dittmar Boeckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinik Heidelberg, Heidelberg, Deutschland
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Turrini F, Scarlini S, Mannucci C, Messora R, Giovanardi P, Magnavacchi P, Cappelli C, Evandri V, Zanasi A, Romano S, Cavani R, Ghidoni I, Tondi S, Bondi M. Does coronary Atherosclerosis Deserve to be Diagnosed earlY in Diabetic patients? The DADDY-D trial. Screening diabetic patients for unknown coronary disease. Eur J Intern Med 2015; 26:407-13. [PMID: 26058988 DOI: 10.1016/j.ejim.2015.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/27/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate if screening and treatment of asymptomatic coronary artery disease (CAD) are effective in preventing first cardiac event in diabetics. METHODS Diabetic patients without known CAD were randomly assigned to undergo a screening for silent myocardial ischemia followed by revascularization or to continue follow-up. The reduction of cardiac death (CD) or nonfatal myocardial infarction (MI) represented the primary aim; secondary aim was the prevention of heart failure (HF). RESULTS From September 2007 to May 2012, 520 patients (62 years; 104 female) were enrolled. Silent CAD was found in 20 of 262 patients (7.6%), revascularization was performed in 12 (4.6%). After a mean follow-up of 3.6 years 12 events (4.6%) occurred in the study group and 14 (5.4%) in the follow-up (HR=0.849, 95% CI: 0.393-1.827, P=0.678). The occurrence of first HF episode did not differ between groups: 2 (0.8%) in screened and 7 (2.7%) in follow-up (HR=0.273, 95% CI: 0.057-1.314, P=0.083). Subgroup analysis revealed a significantly lower HF episodes among patients with intermediate cardiovascular risk (Log rank P=0.022). Additionally, when CD and MI were analysed within subgroups, a significant lower number of CDs was observed among older than 60 years (P=0.044). CONCLUSION Screening and revascularization of silent CAD in diabetics, failed to demonstrate a significant reduction in cardiac events and HF episodes. However, our data indicate that further research is warranted in patients older than 60 years and those with an intermediate cardiovascular risk. CLINICALTRIALS.GOV: NCT00547872.
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Affiliation(s)
- Fabrizio Turrini
- Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy.
| | - Stefania Scarlini
- Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy
| | - Caterina Mannucci
- Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy
| | - Roberto Messora
- Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy
| | - Paolo Giovanardi
- Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy
| | - Paolo Magnavacchi
- Cardiology Clinic, Department of Cardiovascular Disease, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy
| | - Carlo Cappelli
- Cardiology Clinic, Department of Cardiovascular Disease, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy
| | - Valeria Evandri
- Geriatrics Clinic, Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, University of Modena, Via Giardini 1355, 41125 Modena, Italy
| | - Andrea Zanasi
- Geriatrics Clinic, Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, University of Modena, Via Giardini 1355, 41125 Modena, Italy
| | - Stefania Romano
- Diabetology Service, AUSL Modena, Via del Pozzo 71, 41124 Modena, Italy
| | - Rita Cavani
- Diabetology Service, AUSL Modena, Via del Pozzo 71, 41124 Modena, Italy
| | - Italo Ghidoni
- Department of Cardiovascular and Thoracic Surgery, Hesperia Hospital, Modena, Via Arquà 80, 41125 Modena, Italy
| | - Stefano Tondi
- Cardiology Clinic, Department of Cardiovascular Disease, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy
| | - Marco Bondi
- Cardiovascular Medicine Clinic, Department of Internal Medicine, Nuovo Ospedale Civile Sant'Agostino Estense, AUSL Modena, Via Giardini 1355, 41125 Modena, Italy
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Dovzhanskiy DI, Hackert T, Krumm J, Hinz U, Roggenbach J, Hofer S, Büchler MW, Werner J. Clinical impact of perioperative myocardial infarction after pancreatic surgery. J Gastrointest Surg 2014; 18:929-34. [PMID: 24424714 DOI: 10.1007/s11605-014-2453-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/02/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the incidence, clinical impact and outcome of perioperative myocardial infarction (PMI) in patients undergoing pancreatic surgery. METHODS A data of 1,625 patients undergoing pancreatic resection were prospectively collected and analysed with regard to PMI. Demographic aspects, co-morbidities and clinical course were evaluated. Cardiac risk factors (ASA and NYHA), postoperative complications and mortality were compared in a match-pair analysis (1:3) with patients without PMI. RESULTS Twenty-nine patients with PMI after pancreatic surgery were identified. PMI occurred after all types of pancreatic operations and was observed most frequently (72.2%) within the first postoperative week. In a total of 90%, PMI fulfilled the criteria of non-STEMI. Nearly half of the patients (48%) were clinically asymptomatic. Both ASA III and heart failure were more frequent in patients with PMI. The in-hospital mortality was significantly increased after PMI (p < 0.002), with post-pancreatectomy haemorrhage (PPH) as the most relevant underlying risk factor. CONCLUSION PMI is a rare but severe complication after pancreatic operations, contributing significantly to in-hospital mortality. Clinical management mainly includes an anti-coagulant approach. This may be related with an increased risk for PPH. Therefore, the use of anti-coagulant drugs in the early postoperative period-especially in asymptomatic patients-should be critically evaluated.
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Affiliation(s)
- Dmitriy I Dovzhanskiy
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany,
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Collart P, Coppieters Y, Dramaix M, Levêque A. [Acute myocardial infarction in Charleroi: evolution of risk factors and therapeutic practices]. Ann Cardiol Angeiol (Paris) 2013; 62:233-40. [PMID: 23830568 DOI: 10.1016/j.ancard.2013.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 04/27/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the study consists in analyzing the evolution of acute coronary risk factors as well as the 28 days case fatality and the therapeutic practices over 12 years of follow-up in Charleroi. The factors influencing the mortality of these patients are also investigated. METHODS The Charleroi register of ischaemic cardiopathies is the oldest register of infarctions in the French-speaking community of Belgium. Analyses presented hereafter relate only patients in the 25-69-year age range over time from 1998 to 2009. Some analysis was extended to 25-74-year range. Treatment and risk factors evolutions over time were analysed using Chi(2) tests. Logistic regression was used to identify factors influencing 28 days mortality. RESULTS The analysis shows a significant decline in 28 days mortality. A marked increase in the prevalence of hypertension and hypercholesterolemia is highlighted as well as an increase of utilization of percutaneous transluminal coronary angioplasty (PTCA) between 1998 and 2009. The use of ß-blockers and antiplatelet drugs remained fairly stable between 1998 and 2009 with approximately 75% and 90% of the patients treated, respectively. The factors associated with fatality were specifically age of patients, antecedents of diabetes and antecedents of myocardial infarction, hypercholesterolaemia as well as oral antiplatelet drugs, ß-blockers therapies and PTCA. CONCLUSIONS The evolution of the therapeutic data on AMI in this register confirms that PTCA becomes the main coronary reperfusion. Angiotensin-converting enzyme inhibitors were without effect on mortality.
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Affiliation(s)
- P Collart
- Centre de recherche épidémiologie, biostatistiques et recherche clinique, École de santé publique, université Libre de Bruxelles (ULB), route de Lennik 808, CP 596, 1070 Bruxelles, Belgique.
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