Introduction Vascular surgeries are related to high cardiac morbidity and mortality, and the maintenance of aspirin in the perioperative period has a protective effect. The purpose of this study was ...to evaluate the association between preoperative platelet aggregability and perioperative cardiovascular (CV) events. Methods A preoperative platelet aggregation test was performed on an impedance aggregometer in response to collagen and to arachidonic acid (AA) for 191 vascular surgery patients under chronic use of aspirin. We analyzed the following CV events: acute myocardial infarction, unstable angina, isolated troponin elevation, acute ischemic stroke, reoperation, and cardiac death. Hemorrhagic events were also evaluated and classified according to the Thrombolysis In Myocardial Infarction criteria. Results The incidence of CV events was 22% (n = 42). Higher platelet response to AA was associated with CV events, so that patients in the fourth quartile (higher than 11Ω) had almost twice the incidence of CV events when compared with the three lower quartiles: 35% vs 19%; P = .025. The independent predictors of CV events were hemodynamic instability during anesthesia (odds ratio OR, 4.12; 95% confidence interval CI, 1.87-9.06; P < .001), dyslipidemia (OR, 3.9; 95% CI, 1.32-11.51; P = .014), preoperative anemia (OR, 2.64; 95% CI, 1.19-5.85; P = .017), and AA platelet aggregability in the upper quartile (OR, 2.48; 95% CI, 1.07-5.76; P = .034). Platelet aggregability was not associated with hemorrhagic events, even when we compared the lowest quartile of AA platelet aggregability (0-1.00 Ω) with the three upper quartiles (>1.00 Ω; OR, 0.77; 95% CI, 0.43-1.37; P = .377). Conclusions The degree of aspirin effect on platelet aggregability maybe important in the management of perioperative CV morbidity, without increment in the bleeding toll.
Perioperative Myocardial Infarction Has Been Forgotten Gualandro, Danielle Menosi, MD; Caramelli, Bruno, MD, PhD; Yu, Pai Ching, MD ...
Journal of the American College of Cardiology,
05/2008, Letnik:
51, Številka:
18
Journal Article
Recenzirano
Odprti dostop
When the consensus document of the Joint European Society of Cardiology/American College of Cardiology redefinition of MI was released, Tunstall-Pedoe (2) indicated several problems with that ...document.
The advances in surgical technique were notable and now allow procedures in a broader population including high-risk patients. ...there has been a steep increase in the number of major surgical ...procedures performed in these high-risk patients, raising the perioperative cardiovascular event rates.
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