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Review of a Large Clinical Series: Perioperative Myocardial Infarction in Low-Risk Patients Undergoing Noncardiac Surgery Is Associated With Intraoperative Hypotension

Departments of Surgery and Medicine, Stamford Hospital, Stamford, Conn, drjbarone{at}stamhosp.chime.org

Marcia B. Bull, MD, FACP, FACCP, FCCC, FACC

Departments of Surgery and Medicine, Stamford Hospital, Stamford, Conn

Edward H. Cussatti, MD

Departments of Surgery and Medicine, Stamford Hospital, Stamford, Conn

Kevin D. Miller, MD

Departments of Surgery and Medicine, Stamford Hospital, Stamford, Conn

James B. Tucker, RN, MBA

Departments of Surgery and Medicine, Stamford Hospital, Stamford, Conn

This is an investigation of the association of intraoperative hypotension and perioperative myocardial infarction (MI) in low-risk patients undergoing noncardiac surgery. The case-control study compared all patients who experienced perioperative MI during the years 1996 through 1999 to a similar group of patients matched for multiple variables. Perioperative MI occurred in 22 patients. Two patients, who underwent unusual surgical procedures, were excluded from the study. The remaining 20 MI patients were compared with 40 patients who had the same types of surgery and similar mean ages, co-morbidities and preoperative evaluations. Of the patients suffering a perioperative MI, 14 (70%) experienced intraoperative hypotension, as opposed to 11 (28%) of those who did not have an MI (P = .002). Six (30%) MI patients died as opposed to only one (2.5%) of the non-MI group (P = .004). When subjected to logistic regression analysis, intraoperative hypotension remained the only significant variable associated with perioperative MI ( P = .0056). Intraoperative hypotension is associated with an increased risk of perioperative myocardial infarction and death.

Key Words: hypotension • myocardial infarction • perioperative complications • perioperative mortality

Journal of Intensive Care Medicine, Vol. 17, No. 5, 250-255 (2002)
DOI: 10.1177/088506602237108


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