Predictors of Post-Operative Myocardial Infarction After Carotid Endarterectomy
Anjeza Zholanji, DO, David O'Connor, MD, Erica Amianda, MS, Tracy Andrews, PhD, Themba Nyirenda, PhD, Michael Wilderman, MD, Anjali Ratnathicam, DO, Massimo Napolitano, MD, Gregory Simonian, MD.
Hackensack UMC, Hackensack, NJ, USA.
Objective(s): Myocardial infarction (MI) is one of the complications that can occur after carotid endarterectomy (CEA). Our objective in this study was to perform a wide-based analysis of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database in an attempt to identify risk factors associated with occurrence of MI in the 30-day post-procedure period.
Methods: The ACS NSQIP database was queried among all participating institutions for CEAs performed between 2011-2015. Patient demographic data, co-morbid conditions, pre-procedure medications, and operative variables were analyzed using multivariate logistic regression analysis to determine predictors of post-operative MI.
Results: 18,045 CEAs were available for review from the NSQIP database, of which 325 (1.95%) patients developed a post-operative MI within 30 days. The incidence of MI increased by 0.2% (95% CI 1.000-1.0004; P=0.01) for each additional minute of operative time. Patients with an American Society of Anesthesiologists (ASA) classification of 4-5 were 56% more likely to experience a post-operative MI (CI 1.22-1.98; P=0.0003). Patients 80 years or older were 70% more likely to experience an MI (CI 1.34-2.14; P<0.0001). Approximately 2 times the risk of post-operative MI was found to occur in patients who were not functionally independent (CI 1.27-2.99; P=0.0022), and in patients with a history of congestive heart failure (CI 1.34-3.80; P=0.0021). Mortality was associated with an 8.1 times higher risk of post-operative MI (CI 5.18-12.71; P<0.0001). Pre-operative beta-blocker use was not associated with a decreased risk of post-operative MI (CI 1.42-2.26; P<0.0001).
Conclusions: The predictors of an MI occurring within a 30-day period after CEA include: longer operation time, ASA classification 4-5, age 80 years or older, absence of functional independency prior to procedure, history of congestive heart failure. MI occurred more often in patients who expired within the 30-day post-operative period. Beta-blocker use did not decrease the risk of post-operative MI.
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