Cardiac Risk of Noncardiac Surgery in Patients with Asymmetric Septal Hypertrophy

1996 ◽  
Vol 85 (2) ◽  
pp. 254-259 ◽  
Author(s):  
Michael J. Haering ◽  
Mark E. Comunale ◽  
Robert A. Parker ◽  
Edward Lowenstein ◽  
Pamela S. Douglas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Major Surgery ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Asymmetric Septal Hypertrophy ◽  
Septal Hypertrophy

Background Many data are available regarding cardiac risk in patients with coronary artery disease undergoing noncardiac surgery, but few data are available regarding risk for patients with hypertrophic cardiomyopathy and asymmetric septal hypertrophy. Methods Seventy-seven patients with asymmetric septal hypertrophy were identified in whom an echocardiogram had been performed within 24 months of noncardiac surgery. Patients' charts were reviewed for data regarding surgical operations, including length of surgery, type of anesthesia, and intravascular monitoring used. Data regarding adverse perioperative cardiac events also were gathered. Results Forty percent (n = 31) of patients had one or more adverse perioperative cardiac events, including one patient who had a myocardial infarction and ventricular tachycardia that required emergent cardioversion. There were no perioperative deaths. All 31 patients had minor outcomes. Of the 77 patients, perioperative congestive heart failure developed in 12 (16%). Factors associated with adverse cardiac events were increasing length of surgical time (P < 0.01) major surgery (P < 0.05), and intensity of monitoring (P < 0.05). Age, gender, resting outflow tract gradient, systolic anterior motion of the anterior mitral leaflet, prior myocardial infarction, severity of mitral regurgitation, type of anesthetic, septal thickness, and the interval between echocardiogram and surgery were not associated with the occurrence of adverse cardiac events. Conclusion Patients with asymmetric septal hypertrophy undergoing noncardiac surgery have a high incidence of adverse cardiac events, frequently manifested as congestive heart failure. However, irreversible cardiac morbidity and mortality was extremely low. Important independent risk factors for adverse outcome in all patients include major surgery and increasing duration of surgery.

scholarly journals Incidence of postoperative, major, adverse cardiac events in patients undergoing carotid endarterectomy: A single-center, retrospective study

2022 ◽  
Vol 10 ◽  
pp. 205031212110703
Author(s):  
Aphichat Suphathamwit ◽  
Chutima Leewatchararoongjaroen ◽  
Pongprueth Rujirachun ◽  
Kittipatr Poopong ◽  
Apichaya Leesakul ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Retrospective Study ◽  
Confidence Interval ◽  
Carotid Endarterectomy ◽  
Major Adverse Cardiac Events ◽  
Single Center ◽  
Cardiac Events ◽  
Adverse Cardiac Events

Objective: This study aimed to determine the incidence of postoperative major adverse cardiac events for patients undergoing carotid endarterectomy. Methods: This single-center, retrospective study recruited 171 carotid endarterectomy patients between January 1999 and June 2018. Patients who received a carotid endarterectomy in conjunction with other surgery were excluded. The primary outcomes were the incidences of major adverse cardiac events (comprising myocardial infarction, significant arrhythmias, congestive heart failure, and cardiac death) within 7 days, 7–30 days, and > 30 days–1 year, postoperatively. The secondary outcomes were the factors related to major adverse cardiac events and the incidence of postoperative stroke. The patients’ charts were reviewed, and direct contact was made with them to obtain information on their status post discharge. Results: The incidences of major adverse cardiac events within 7 days, 7–30 days, and >30 days–1 year of the carotid endarterectomy were 3.5% of patients (95% confidence interval: 0.008–0.063), 1.2% (95% confidence interval: 0.004–0.028), and 1.8% (95% confidence interval: 0.002–0.037), respectively. The major adverse cardiac events occurring within 7 days were arrhythmia (2.3% of patients), cardiac arrest (1.8%), myocardial infarction (1.2%), and congestive heart failure (1.2%), while the corresponding postoperative stroke rate was 4.7%. Conclusion: The 7-day incidence of major adverse cardiac events after the carotid endarterectomy was 3.5%. The most common major adverse cardiac event during that period was cardiac arrhythmia.

Clinical Significance of Cardiac Co-Morbidities and Risk Factors for Patients Treated with Imatinib.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4490-4490
Author(s):  
Asifa Malik ◽  
Jorge E. Cortes ◽  
Hagop Kantarjian ◽  
Gloria Mattiuzzi ◽  
Gloria Iliescu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Research Funding ◽  
Cardiac Risk ◽  
Imatinib Treatment ◽  
Cardiac Events ◽  
Cardiac Risk Factors ◽  
History Of

Abstract Abstract 4490 Background: Imatinib is currently standard therapy for patients with success in Chronic Myeloid Leukemia (CML). Several instances of cardiac adverse events have been reported for patients while on therapy with imatinib. In many instances, these events occur in patients with pre-existing cardiac conditions. The aim of our study was to determine the occurrence of cardiac events in patients with CML treated with Imatinib, and the impact that cardiac risk factors and pre-existing cardiac conditions had on the risk of developing cardiac adverse effects. Methods: We reviewed the medical records of 51 patients with chronic phase CML who were treated with imatinib after failing prior therapies. For each patient we collected cardiac risk factors, pre-existing cardiac disease, pre-treatment EKG and echocardiogram (ECHO) readings, as well as post-treatment changes in EKG and ECHO findings. Results: Pre-existing cardiac conditions were found in 14 (27%) patients, including congestive heart failure in 2 (4%), myocardial infarction in 4 (8%), atrial fibrillation in 1 (2%), benign arrhythmias in 1(2%), aortic regurgitation in 1(2%), mitral valve prolapse in 1 (2%), mitral regurgitation in 1(2%), pericarditis in 1(2%), bradycardia in1(2%) and benign arrhythmia in 1(2%). Cardiac risk factors were present in 26 patients (51%), including smoking in 10 patients (20%), hypertension in 17 (33%), diabetes mellitus in 9 (18%), obesity in 2 (4%), hyperlipidemia in 5 (10%), stress (self-reported by patient or on anxiolytic therapy) in 5 (10%), alcohol in 11 (22%), atherosclerosis in 3 (6%), and positive family history for cardiac disease in 5 patients (9.8%). Cardiac events were noted in 19 patients (37%) of whom 11 (58%) had pre-existing cardiac conditions prior to initiating imatinib treatment and 14 patients (27%) had at least one cardiac risk factor. Congestive heart failure with clinical manifestations was seen in 9 patients (18%) with documentation of decreased ejection fraction on echocardiogram seen in 3 patients (6%) who had a decrease in LVEF from a median of 55% (range 50% to 72%) to a median of 45% (range 25% to 60%). Out of the patients who developed CHF while on treatment with imitanib, 3 patients (6%) had history of cardiac conditions (atrial fibrillation in 1 (2%), congestive heart failure in 2 (4%)). Myocardial infarction was documented in 3 patients (6%), one of which had prior myocardial infarction and pacemaker, another had history of mitral valve prolapse and hypertension; one patient had hypertension, diabetes mellitus and positive family history but no prior history of heart disease. Arrhythmia was seen in 3 patients (6%). Post-treatment EKG changes occurred in 14 patients (27%) including bradycardia, PAC's, PVC's, ST-T wave changes, tachycardia and other rhythm abnormalities. These changes were usually asymptomatic. Gated cardiac study done after a median of 63 months (range 29 to 83 months) after initiation of imatinib treatment showed EF below 60% in 9 patients (18%) with a median of 55% (range 36% to 59%). None of the patients died of cardiac conditions and none discontinued imatinib therapy because of cardiac events. Conclusion: Although cardiac events occur in some patients treated with imatinib, these are much more common among patients with pre-existing cardiac conditions and/or cardiac risk factors. These patients need to be monitored closely to minimize their risk and intervene early when new cardiac events arise. Disclosures: Cortes: novartis: Research Funding; BMS: Research Funding; Pfizer: Consultancy, Research Funding. Kantarjian:novartis: Research Funding; BMS: Research Funding. O'Brien:Novartis: Research Funding.

Association of Stress hyperglycemia and adverse cardiac events in acute myocardial infarction – A cohort study

2021 ◽  
Vol 22 ◽  
Author(s):  
Annu Rajpurohit ◽  
Bharat Sejoo ◽  
Rajendra Bhati ◽  
Prakash Keswani ◽  
Shrikant Sharma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Blood Glucose ◽  
Clinical Outcomes ◽  
P Value ◽  
Cardiac Events ◽  
Stress Hyperglycemia ◽  
Adverse Cardiac Events ◽  
Hba1c Levels

Background: Stress hyperglycemia is a common phenomenon in patients presenting with acute myocardial infarction (MI). We aim to evaluate the association of stress hyperglycemia at the time of hospital presentation and adverse cardiac events in myocardial infarction during the course of hospital stay. Methods: Subjects with age ≥18 years with acute MI were recruited on hospital admission and categorized based on admission blood glucose (<180 and ≥180 mg/dl, 50 patients in each group). Both groups were compared for clinical outcomes, adverse cardiac events and mortality. We also compared the adverse cardiac outcomes based on HbA1c levels (<6% and ≥6%). Results: Patients with high blood glucose on admission (stress hyperglycemia) had significant increased incidences of severe heart failure (Killip class 3 and 4), arrythmias, cardiogenic shock and mortality (p value = 0.001, 0.004, 0.044, and 0.008 respectively). There was no significant association between adverse cardiac events and HbA1c levels (heart failure 18.8% vs. 25%, p value = 0.609 and mortality 16.7% vs. 17.3%, p value = 0.856). Conclusions: Stress hyperglycemia is significantly associated with adverse clinical outcomes in patients with MI irrespective of previous diabetic history or glycemic control. Clinicians should be vigilant for admission blood glucose while treating MI patients.

scholarly journals Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

2021 ◽  
Vol 18 (4) ◽  
pp. 62-72
Author(s):  
D. A. Sokolov ◽  
P. A. Lyuboshevsky ◽  
I. N. Staroverov ◽  
I. A. Kozlov
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Surgery ◽  
Chronic Heart Failure ◽  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Cardiac Events ◽  
Risk Indices ◽  
Medium Risk ◽  
Potential Risk Factors

The objective: to analyze the incidence and spectrum of cardiovascular complications within 12 months after noncardiac surgery, as well as to assess the association of preoperative values of various cardiac risk indices (CRI) and other potential risk factors with the actual development of complications.Subjects and Methods. We analyzed data of medical records and telephone interviews of 141 patients aged 65 [60-71] years who had undergone non-cardiac surgery a year before the interview The operations were low risk in 13.5% of observations, medium risk in 64.5%, and high risk in 22%. A retrospective calculation of the Revised CRI (RCRI), Individual CRI (Khoronenko CRI), and the American College of Surgeons Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) was performed.Results. Cardiac events (myocardial infarction, decompensation of chronic heart failure, new arrhythmias, stroke, and/or the need to prescribe or escalate the dose of cardiovascular drugs and/or hospitalization for cardiac indications, and/or death from cardiovascular diseases) within 12 months after elective noncardiac surgeries were detected in 27.7% of cases, and in 2.1% of patient's death occurred due to cardiac disorders. Predictors of cardiac events were concomitant ischemic heart disease (OR = 2.777; 95% CI 1.286-5.966; p = 0.0093) and chronic heart failure (OR = 2.900; 95% CI 1.224-6.869; p = 0, 0155), RCRI (OR = 1.886; 95% CI 1.2-8-2.944; p = 0.005), Khoronenko CRI (OR = 3254.3; 95% CI 64.33-164,638; p = 0.0001), MICA (OR = 1.628; 95% CI 1.156-2.292; p = 0.005), creatininemia on the first postoperative day (OR = 1.023; 95% CI 1.010-1.061; p = 0.005), and propensity for bradycardia during surgery (OR = 0.945; 95% CI 0.908-0.983; p = 0.005). Combined analysis of Khoronenko's CRI and postoperative creatininemia provided a very good model: area under the ROC-curve - 0.823 (95% CI 0.728-0.641; p = 0.0002).Conclusion. All studied CRIs can be used to predict posthospital cardiac events; however, the most promising is a joint assessment of Khoronenko's CRI and postoperative creatinemia.

scholarly journals Risk prediction of major adverse cardiac events by high sensitivity troponin is modified by comorbidities

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Cohen ◽  
S Mahler ◽  
R Christenson ◽  
B Allen ◽  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
High Sensitivity ◽  
Comorbid Conditions ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events ◽  
Artery Disease ◽  
Prior Stroke

Abstract Background High-sensitivity cardiac troponin (hs-cTn) is a well-established biomarker for the evaluation of Emergency Department (ED) patients with possible acute coronary syndrome. These patients often have comorbid conditions that may impact hs-cTn values. However, prior studies and current guidelines addressing the relationship between comorbidities and hs-cTn are limited. Purpose To determine whether an interaction exists between comorbidities and baseline hsTnT values on the risk of 30-day major adverse cardiac events (MACE) in a multicenter United States (US) cohort. Methods Adult ED patients with suspected acute coronary syndrome were prospectively enrolled in a multicenter cohort study in the US. Baseline blood samples were collected and hs-cTnT concentrations were measured at a central laboratory. Comorbid conditions, such as obesity, hypertension, hyperlipidemia, diabetes, coronary artery disease, congestive heart failure, renal disease, peripheral vascular disease, prior stroke, and history of coronary interventions, were collected at time of enrollment. The primary outcome was adjudicated MACE, defined as occurrence of myocardial infarction, cardiovascular or uncertain death, or coronary revascularization within 30 days. Hs-cTnT values were dichotomized using manufacturer's limit of quantification (LOQ) at 6 ng/dL and the upper reference limit (URL) of 19 ng/dL. The utility the LOQ and URL cut-offs in predicting MACE was evaluated using logistic regression. Effect modification of comorbid conditions was independently evaluated by including an interaction term between comorbidity and hs-cTnT. Results Among 1460 participants with a baseline hs-cTn measurement, 46.3% (676/1460) were female and 37.1% (542/1460) were Black with a mean age of 57.6±12.9 years. The prevalence of MACE was 14.4% (210/1460). Participants with a baseline hs-cTnT below LOQ were 0.08 (95% CI: 0.04–0.16) times less likely to have MACE compared to those exceeding LOQ. Those with a baseline hs-cTnT exceeding URL were 9.5 (95% CI: 7.0–12.9) times more likely to have MACE. The presence of prior stroke significantly modified the association between baseline hs-cTnT below LOQ and risk of MACE (p=0.006). Among those with prior stroke (n=158), there was no significant association between baseline hs-cTnT below LOQ and risk of MACE (p=0.451). For the association between hs-cTnT above URL and MACE, significant negative interaction was detected by hypertension (p&lt;0.001), hyperlipidemia (p=0.002), coronary artery disease (p=0.002), percutaneous coronary intervention (p=0.001), and congestive heart failure (p=0.038) comorbidity. Conclusion In a diverse, multicenter, US cohort the association between baseline hs-cTnT and the risk of MACE was weakened by the presence of several comorbid conditions. This suggests that the safety of previously validated hs-cTnT diagnostic strategies may be diminished when applied to populations with a high prevalence of comorbid conditions. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Roche Diagnostics

Cardiac Risk of Noncardiac Surgery in Patients with Asymmetric Septal Hypertrophy

1994 ◽  
Vol 81 (SUPPLEMENT) ◽  
pp. A1293 ◽  
Author(s):  
J. M. Haering ◽  
H. M. Krumholz ◽  
M. E. Comunale ◽  
P. S. Douglas ◽  
W. J. Manning
Keyword(s):  
Cardiac Risk ◽  
Noncardiac Surgery ◽  
Asymmetric Septal Hypertrophy ◽  
Septal Hypertrophy

scholarly journals Higher risk of major adverse cardiac events after acute myocardial infarction in patients with schizophrenia

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001286
Author(s):  
Rubina Attar ◽  
Axel Wester ◽  
Sasha Koul ◽  
Svend Eggert ◽  
Christoffer Polcwiartek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cox Regression ◽  
Major Adverse Cardiac Events ◽  
Chronic Obstructive ◽  
High Risk Population ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
All Cause Mortality

BackgroundPatients with schizophrenia are a high-risk population due to higher prevalences of cardiovascular risk factors and comorbidities that contribute to shorter life expectancy.PurposeTo investigate patients with and without schizophrenia experiencing an acute myocardial infarction (AMI) in relation to guideline recommended in-hospital management, discharge medications and 5-year major adverse cardiac events (MACE: composite of all-cause mortality, rehospitalisation for reinfarction, stroke or heart failure).MethodsAll patients with schizophrenia who experienced AMI during 2000–2018 were identified (n=1008) from the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and compared with AMI patients without schizophrenia (n=2 85 325). Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations.ResultsPatients with schizophrenia presented with AMI approximately 10 years earlier (median age 64 vs 73 years), and had higher prevalences of diabetes, heart failure and chronic obstructive pulmonary disease. They were less likely to be invasively investigated or discharged with aspirin, P2Y12 inhibitors, ACE inhibitors/angiotensin II receptor blockers, beta-blockers and statins (all p<0.005). AMI patients with schizophrenia had higher adjusted risk of MACE (aHR=2.05, 95% CI 1.63 to 2.58), mortality (aHR=2.38, 95% CI 1.84 to 3.09) and hospitalisation for heart failure (aHR=1.39, 95% CI 1.04 to 1.86) compared with AMI patients without schizophrenia.ConclusionPatients with schizophrenia experienced an AMI almost 10 years earlier than patients without schizophrenia. They less often underwent invasive procedures and were less likely to be treated with guideline recommended medications at discharge, and had more than doubled risk of MACE and all-cause mortality. Improved primary and secondary preventive measures, including adherence to guideline recommendations, are warranted and may improve outcome.

scholarly journals In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zubair Akhtar ◽  
Mohammad Abdul Aleem ◽  
Probir Kumar Ghosh ◽  
A. K. M. Monwarul Islam ◽  
Fahmida Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Multivariate Analysis ◽  
Cardiac Events ◽  
Post Discharge ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Adverse Cardiac Events

Abstract Background There is a paucity of data regarding acute phase (in-hospital and 30-day) major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh. This study aimed to document MACE during the acute phase post-STEMI to provide information. Methods We enrolled STEMI patients of the National Institute of Cardiovascular Disease, Dhaka, Bangladesh, from August 2017 to October 2018 and followed up through 30 days post-discharge for MACE, defined as the composite of all-cause death, myocardial infarction, and coronary revascularization. Demographic information, cardiovascular risk factors, and clinical data were registered in a case report form. The Cox proportional hazard model was used for univariate and multivariate analysis to identify potential risk factors for MACE. Results A total of 601 patients, mean age 51.6 ± 10.3 years, 93% male, were enrolled. The mean duration of hospital stay was 3.8 ± 2.4 days. We found 37 patients (6.2%) to experience an in-hospital event, and 45 (7.5%) events occurred within the 30 days post-discharge. In univariate analysis, a significantly increased risk of developing 30-day MACE was observed in patients with more than 12 years of formal education, diabetes mellitus, or a previous diagnosis of heart failure. In a multivariate analysis, the risk of developing 30-day MACE was increased in patients with heart failure (hazard ratio = 4.65; 95% CI 1.64–13.23). Conclusions A high risk of in-hospital and 30-day MACE in patients with STEMI exists in Bangladesh. Additional resources should be allocated providing guideline-recommended treatment for patients with myocardial infarction in Bangladesh.

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