Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/jvb.2013.059
Jornal Vascular Brasileiro
Original Article

Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

Infarto agudo do miocardio em pacientes portadores de isquemia critica submetidos a revascularizacao de membros inferiores

Esdras Marques Lins; Jose Wellington Barros; Fernanda Appolonio; Eduardo Anacleto; Eduardo Cavalcanti Lima

http://dx.doi.org/10.1590/jvb.2013.059 J Vasc Bras, vol.12, n4, p.284-288, 2013
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Abstract

BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD) of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours). RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6%) of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

Keywords

peripheral arterial disease, myocardial infarction, postoperative period

Resumo

CONTEXTO: A doença arterial obstrutiva periférica (DAOP) afeta os membros inferiores (MMII) e tem como principal causa a aterosclerose. Por se tratar de uma doença sistêmica, é frequente que a aterosclerose cause o envolvimento simultâneo de outros sítios arteriais, especialmente das artérias coronárias. Desta forma, os pacientes submetidos a cirurgia de reconstrução arterial periférica, devido a isquemia crítica dos MMII, apresentam maior chance de infarto agudo do miocárdico (IAM). Apesar disso, há na literatura poucos relatos que avaliem a prevalência do IAM adequadamente neste grupo de pacientes. OBJETIVO: Avaliar incidência do infarto agudo do miocárdio no pós-operatório imediato de pacientes submetidos à revascularização de MMII devido a DAOP. MATERIAL E MÉTODOS: Foram avaliados 64 pacientes portadores de DAOP submetidos a 82 cirurgias de revascularização arterial dos MMII, no período de fevereiro de 2011 a julho de 2012. Os pacientes foram submetidos no pós-operatório imediato (até 72 horas) a eletrocardiograma (ECG) e dosagem sanguínea de troponina I cardíaca. RESULTADOS: Considerando as 82 cirurgias realizadas, em cinco (6%) casos, foram encontradas alterações no ECG e elevação sanguínea da troponina I cardíaca compatíveis com infarto agudo do miocárdio. Considerando apenas as 52 cirurgias feitas por técnica convencional, a incidência de IAM foi de 9,6%. Dois pacientes evoluíram ao óbito. CONCLUSÃO: No presente estudo, a incidência do infarto agudo do miocárdio nos pacientes submetidos à revascularização arterial de membros inferiores por DAOP foi de 6%. Considerando apenas as cirurgias feitas por técnica convencional, a incidência de IAM foi de 9,6%.

Palavras-chave

doenca arterial periferica, infarto do miocardio, periodo pos-operatorio

References

Norgren L, Hiatt WR, Dormandy JA, Nehler KAH, Fowkes FGR on behalf of the TASC II working Group. Inter-Society Consensus for the management of peripheral Arterial Disease (TASC II). J Vasc Bras. ;6(Supl 2):S193-S259.

Iran castro. II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol. ;96(3 supl.1):1-68.

Lastoria S, Maffei FHA. Aterosclerose Obliterante Periférica: Epidemiologia, Fisiopatologia, Quadro Clínico e Diagnóstico. Doenças Vasculares Periféricas. :1141-155.

Mello AV, Dos Santos CMT, Oliveira BC, Mello RV. Revascularização distal dos membros inferiores: experiência de 13 anos. J Vasc Bras. ;1:181-92.

Mourad JJ, Cacoub P, Collet JP. Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD. J Vasc Surg. ;50:572-80.

Kim LJ, Martinez EA, Faraday N. Cardiac troponin-I predicts short-term mortality in vascular surgery patients. Circulation. ;106:2366-371.

Kertai JH, Boersma E, Bax JJ. A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart. ;89(11):1327-334.

Scrutinio D, Passantino A, Di Serio F, Angilleta D, Santoro D, Regina G. High-sensitivity C-reactive protein predicts cardiovascular events and myocardial damage after vascular surgery. J Vasc Surg. ;54:474-79.

Frankini AD, Pezzella MVC. Revascularização no pé em paciente com isquemia crítica. J Vasc Br. ;1(3):193-200.

Boersma E, Kertai MD, Schouten O. Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med. ;118(10):1134-141.

Landesberg G, Mosseri M, Shatz V. Cardiac Troponin After Major Vascular Surgery. JACC. ;44:569-75.

Raby KE, Barry J, Creager MA, Cook EF, Weisberg MC, Goldman L. Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. JAMA. ;268(2):222-27.

Bolliger D, Seeberger MD, Lurati Buse GA. A preliminary report on the prognostic significance of preoperative brain natriuretic peptide and postoperative cardiac troponin in patients undergoing major vascular surgery. Anesth Analg. ;108(4):1069-075.

Back MR, Leo F, Cuthbertson D, Johnson BL, Shamesmd ML, Bandyk DF. Long-term survival after vascular surgery: specific influence of cardiac factors and implications for preoperative evaluation. J Vasc Surg. ;40(4):752-60.

Williams FM, Bergin JD. Cardiac screening before noncardiac surgery. Surg Clin North Am. ;89(4):747-62.

Waggoner AD, Sicard GA, Geltman EM, Schechtman KB, Pérez JE. Dobutamine stress echocardiography predicts surgical outcome in patients with an aortic aneurysm and peripheral vascular disease. J Am Coll Cardiol. ;21(4):957-63.

Poldermans D, Bax JJ, Boersma E. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J. ;30:2769-812.

Thygesen K, Alpert SJ, Jaffe SA. Third Universal Definition of Myocardial Infarction. JACC. :60-0.

Monaco M, Stassano P, Di Tommaso L. Systematic strategy of prophylactic coronary angiography improves long-term outcome after major vascular surgery in medium- to high-risk patients: a prospective, randomized study. J Am Coll Cardiol. ;54(11):989-96.

Andrews N, Jenkins J, Andrews G, Walker P. Using postoperative cardiac Troponin-I (cTi) levels to detect myocardial ischaemia in patients undergoing vascular surgery. Cardiovasc Surg. ;9(3):254-65.

Haggart PC, Adam DJ, Ludman PF, Bradbury AW. Comparison of cardiac troponin I and creatine kinase ratios in the detection of myocardial injury after aortic surgery. Br J Surg. ;88(9):1196-200.

Barbagallo M, Casati A, Spadini E. Early increases in cardiac troponin levels after major vascular surgery is associated with an increased frequency of delayed cardiac complications. J Clin Anesth. ;18(4):280-85.

McFalls EO, Ward HB, Moritz TE. Predictors and outcomes of a perioperative myocardial infarc- tion following elective vascular surgery in patients with docu- mented coronary artery disease: results of the CARP trial. Eur Heart J. ;29(3):394-401.

Flu JW, Schouten O, Van Kuijk PJ, Poldermans D. Perioperative Cardiac Damage in Vascular Surgery Patients. Eur J Vasc Endovasc Surg. ;40:1-8.

Landesberg G, Mosseri M, Zahger D. Myocardial Infarction After Vascular Surgery: The Role of Prolonged, Stress-Induced, ST Depression-Type Ischemia. JACC. ;37:1839-845.

Landesberg G, Shatz V, Akopnik I. Association of Cardiac Troponin, CK-MB, and Postoperative Myocardial Ischemia With Long-Term Survival After Major Vascular Surgery. JACC. ;42:1547-554.

Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. ;324:71-86.

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