Yeager R A, Moneta G L, Edwards J M, Taylor L M, McConnell D B, Porter J M
Department of Surgery, Oregon Health Sciences University, Portland.
J Vasc Surg. 1994 Oct;20(4):598-604; discussion 604-6. doi: 10.1016/0741-5214(94)90284-4.
Although early death from perioperative myocardial infarction (PMI) after vascular surgery is well established, long-term outcome in patients surviving PMI is unknown. This prospective study was designed to determine cardiac outcome and survival rates in patients with symptomatic and asymptomatic nonfatal PMI associated with peripheral vascular surgery.
During a 36-month period for 1989 to 1992, all patients undergoing vascular surgery at our institution were monitored for PMI with serial creatine kinase and myocardial band isoenzymes and electrocardiography. PMIs were classified as symptomatic (associated with chest pain, arrhythmia, congestive heart failure, or hypotension) or asymptomatic (electrocardiographic changes and/or elevated creatine kinase and myocardial band isoenzymes). Patients with PMI were then prospectively monitored and compared for late survival, with control patients undergoing vascular surgery without PMI during the same interval.
During the study period 1561 major peripheral vascular procedures were performed. There were 47 PMIs (3.0%). Eleven (0.7%) PMIs were fatal, 31 were nonfatal, and five other patients with PMI died during operation of non-heart-related causes. Eight of 31 patients with nonfatal PMI had a "chemical PMI" with creatine kinase and myocardial band isoenzyme elevation as the sole indicator of PMI. During follow-up (mean 27.7 months), there was a higher incidence of both subsequent myocardial infarction and coronary artery revascularization among the patients with nonfatal PMI compared with control subjects (p < 0.05); however, survival for patients with nonfatal PMI at 1 and 4 years (80% and 51%) did not differ from that of control patients (90% and 60%) (p > 0.05). Patients with "chemical PMI" had similar patterns of subsequent myocardial infarction and coronary intervention as control patients.
Patients surviving nonfatal PMI after peripheral vascular surgery have a higher incidence of subsequent adverse cardiac events and coronary artery revascularization than patients undergoing vascular surgery without PMI, but they have similar survival rates at 1 and 4 years. Patients in the enzyme-only PMI group have a similar outcome compared with control subjects suggesting that a perioperative "chemical MI" may not be a significant clinical event.
虽然血管手术后围手术期心肌梗死（PMI）导致的早期死亡已得到充分证实，但PMI存活患者的长期预后尚不清楚。本前瞻性研究旨在确定与外周血管手术相关的有症状和无症状非致命性PMI患者的心脏预后和生存率。
在1989年至1992年的36个月期间，对我院所有接受血管手术的患者进行连续肌酸激酶、心肌带同工酶监测及心电图检查以监测PMI。PMI分为有症状（与胸痛、心律失常、充血性心力衰竭或低血压相关）或无症状（心电图改变和/或肌酸激酶及心肌带同工酶升高）。然后对PMI患者进行前瞻性监测，并与同期接受血管手术但无PMI的对照患者比较晚期生存率。
研究期间共进行了1561例主要外周血管手术。有47例PMI（3.0%）。11例（0.7%）PMI死亡，31例非致命，另有5例PMI患者死于非心脏相关原因的手术中。31例非致命性PMI患者中有8例有“化学性PMI”，以肌酸激酶和心肌带同工酶升高作为PMI的唯一指标。随访期间（平均27.7个月），非致命性PMI患者随后发生心肌梗死和冠状动脉血运重建的发生率均高于对照受试者（p<0.05）；然而，非致命性PMI患者1年和4年的生存率（80%和51%）与对照患者（90%和60%）无差异（p>0.05）。“化学性PMI”患者随后发生心肌梗死和冠状动脉介入治疗的模式与对照患者相似。
外周血管手术后非致命性PMI存活患者随后发生不良心脏事件和冠状动脉血运重建的发生率高于未发生PMI的血管手术患者，但1年和4年生存率相似。仅酶学PMI组患者与对照受试者的预后相似，提示围手术期“化学性心肌梗死”可能不是一个重要的临床事件。
