Anatol J Cardiol. Ahead of Print: AJC-45752 | DOI: 10.14744/AnatolJCardiol.2020.45752

Perioperative Myocardial Damage and The Incidence of Type 2 Myocardial Infarction in Patients with Intermediate and High Cardiovascular Risk

Miraç Vural Keskinler¹, Osman Köstek², Berrin Erok³, Özge Telci Caklýlý⁴, Yavuz Onur Danacýoðlu⁵, Aytekin Oðuz^1
1Department of Internal Medicine, Medeniyet University Göztepe Education and Research Hospital, Istanbul Turkey
²Department Of Oncology, Edirne Sultan 1. Murat State Hospital, Edirne, Turkey
³Department Of Radiology, Cihanbeyli State Hospital, Konya, Turkey
⁴Istanbul University Istanbul Faculty Of Medicine, Department Of Endocrinology, Istanbul, Turkey
⁵Department of Urology, Bakýrkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey

AIM
Perioperative myocardial infarction is an important cause of morbidity and mortality in patients undergoing surgical operation. We aimed to determine the incidence of perioperative myocardial infarction in patients with intermediate or high-risk Framingham score.

MATERIAL/ METHOD
101 patients (62 males,39 females) over 40 years old age (mean age 72±11years), with Framingham risk score of 10% or higher, and scheduled for surgical intervention in orthopedics and urology departments of our hospital were included in the study. Patient demographics, comorbidities, blood pressures and biochemical data were recorded. Troponin values and electrocardiographic findings were obtained at preoperative period and postoperative second day and then compared. Perioperative myocardial injury and infarction were diagnosed using third universal definition of myocardial infarction.

RESULTS
In 44 patients (43%) postoperative troponin values were compared with the preoperative values. In 26 (25%) patients the changes were consistent with myocardial ischemia or damage. Alteration in troponin value with significant ECG change was established in 6 patients (6%).

CONCLUSION
Risk of postoperative myocardial damage is high in our patients with intermediate or high-risk Framingham score. This implies that close follow-up of these patients with ECG and troponin values at pre and postoperative period is required.

Keywords: Perioperative myocardial infarction, type 2 myocardial infarction, cardiovascular risk

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Perioperatif Miyokard Hasarý ve Orta ve Yüksek Kardiovasküler Riskli Hastalarda Tip 2 Miyokard Enfarktüs Ýnsidansý

Miraç Vural Keskinler¹, Osman Köstek², Berrin Erok³, Özge Telci Caklýlý⁴, Yavuz Onur Danacýoðlu⁵, Aytekin Oðuz^1
1Medeniyel Universitesi Göztepe Eðitim Ve Araþtýrma Hastanesi, Iç Hastalýklarý Ana Bilim Dalý, Istanbul
²Edirne Sultan 1. Murat Devlet Hastanesi, Onkoloji Kliniði, Edirne
³Cihanbeyli Devlet Hastanesi, Radyoloji Kliniði, Konya
⁴Istanbul Üniversitesi Istanbul Týp Fakültesi, Endokrinoloji Bilim Dalý, Istanbul
⁵Bakýrköy Sadi Konuk Eðitim ve Araþtýrma Hastanesi, Üroloji Kliniði, Ýstanbul

Amaç: Cerrahi operasyonlar sonrasý miyokard hasarý önemli bir morbidite ve mortalite nedenidir. Bu çalýþmamýzda Framingham skoruna göre orta ve yüksek riskli hastalarýmýzdaki perioperatif miyokard infarktüsü sýklýðýný ortaya koymayý amaçladýk.

Materyal ve metod: Çalýþmaya; hastanemiz Ortopedi ve Üroloji servislerinde yatmakta olan, cerrahi giriþim planlanmýþ, 40 yaþ üzeri, Framingham risk skorlarý %10 ve üzeri olan 101 olgu (62 erkek, 39 kadýn, ortalama yaþ: 72±11 yýl) alýndý. Bu hastalarýn preoperatif dönemdeki demografik özellikleri, komorbid durumlarý, kan basýnçlarý ve biyokimyasal verileri kayýt edildi. Olgularýn preoperatif ve postoperatif ikinci gün troponin deðerleri ve elektrokardiyografik bulgularý kaydedilerek karþýlaþtýrýldý.

Bulgular: Toplam 44 hastada (%43) troponin deðeri postoperatif dönemde preoperatif döneme göre deðiþiklik gösterdi. Hastalarýn %25’inin (26 hasta) elektrokardiyografisinde miyokard iskemisi veya hasarý ile iliþkili olabilecek nitelikte deðiþiklik saptandý. Anlamlý EKG deðiþikliði ile birlikte troponin deðiþikliði 6 hastada (%6) saptandý.

Sonuç: Framingham skoruna göre orta ve yüksek riskli gruba dahil olan hastalarýmýzda postoperatif miyokard hasar riskinin yüksek olduðu görülmüþtür. Bu sonuçlar riskli gruptaki tüm hastalarýn pre ve postoperatif dönemde, EKG ve troponin ile yakýndan takip edilmesinin önemini ortaya koymaktadýr.

Anahtar Kelimeler: Perioperatif myokardial enfarktus, Tip 2 myokardial enfarktus, kardiyovaskuler risk

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