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.
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.
Authors: J Zimmerman; R Fromm; D Meyer; A Boudreaux; C C Wun; R Smalling; B Davis; G Habib; R Roberts Journal: Circulation Date: 1999-04-06 Impact factor: 29.690
Authors: Lee A Fleisher; Joshua A Beckman; Kenneth A Brown; Hugh Calkins; Elliott Chaikof; Kirsten E Fleischmann; William K Freeman; James B Froehlich; Edward K Kasper; Judy R Kersten; Barbara Riegel; John F Robb; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffrey L Anderson; Elliott M Antman; Christopher E Buller; Mark A Creager; Steven M Ettinger; David P Faxon; Valentin Fuster; Jonathan L Halperin; Loren F Hiratzka; Sharon A Hunt; Bruce W Lytle; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Lynn G Tarkington; Clyde W Yancy Journal: Circulation Date: 2007-09-27 Impact factor: 29.690
Authors: E Giannitsis; M Müller-Bardorff; V Kurowski; B Weidtmann; U Wiegand; M Kampmann; H A Katus Journal: Circulation Date: 2000-07-11 Impact factor: 29.690
Authors: W Korte; M Cattaneo; P-G Chassot; S Eichinger; C von Heymann; N Hofmann; H Rickli; M Spannagl; B Ziegler; F Verheugt; K Huber Journal: Thromb Haemost Date: 2011-03-24 Impact factor: 5.249
Authors: D T Mangano; M Hollenberg; G Fegert; M L Meyer; M J London; J F Tubau; W C Krupski Journal: J Am Coll Cardiol Date: 1991-03-15 Impact factor: 24.094