Perioperative Medicine  |   January 2016
Association between Intraoperative Hypotension and Myocardial Injury after Vascular Surgery
Author Notes
  • From the Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands (J.A.R.v.W., W.A.v.K., L.v.W.); Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada (D.N.W., W.S.B.); Department of Health Policy Management and Evaluation; Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada (D.N.W.); and Division of Vascular Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada (T.F.L.).
  • Corresponding article on page 4.
    Corresponding article on page 4.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • An abstract of this article has been presented as a poster at the Annual Meeting of the American Society of Anesthesiologists, October 11, 2014, New Orleans, Louisiana.
    An abstract of this article has been presented as a poster at the Annual Meeting of the American Society of Anesthesiologists, October 11, 2014, New Orleans, Louisiana.×
  • Submitted for publication September 22, 2014. Accepted for publication September 5, 2015.
    Submitted for publication September 22, 2014. Accepted for publication September 5, 2015.×
  • Address correspondence to Dr. van Waes: Department of Anesthesiology, University Medical Center Utrecht, Q04.2.313, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. j.a.r.vanwaes@umcutrecht.nl. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia / Trauma / Burn Care
Perioperative Medicine   |   January 2016
Association between Intraoperative Hypotension and Myocardial Injury after Vascular Surgery
Anesthesiology 1 2016, Vol.124, 35-44. doi:10.1097/ALN.0000000000000922
Anesthesiology 1 2016, Vol.124, 35-44. doi:10.1097/ALN.0000000000000922
Abstract

Background: Postoperative myocardial injury occurs frequently after noncardiac surgery and is strongly associated with mortality. Intraoperative hypotension (IOH) is hypothesized to be a possible cause. The aim of this study was to determine the association between IOH and postoperative myocardial injury.

Methods: This cohort study included 890 consecutive patients aged 60 yr or older undergoing vascular surgery from two university centers. The occurrence of myocardial injury was assessed by troponin measurements as part of a postoperative care protocol. IOH was defined by four different thresholds using either relative or absolute values of the mean arterial blood pressure based on previous studies. Either invasive or noninvasive blood pressure measurements were used. Poisson regression analysis was used to determine the association between IOH and postoperative myocardial injury, adjusted for potential clinical confounders and multiple comparisons.

Results: Depending on the definition used, IOH occurred in 12 to 81% of the patients. Postoperative myocardial injury occurred in 131 (29%) patients with IOH as defined by a mean arterial pressure less than 60 mmHg, compared with 87 (20%) patients without IOH (P = 0.001). After adjustment for potential confounding factors including mean heart rates, a 40% decrease from the preinduction mean arterial blood pressure with a cumulative duration of more than 30 min was associated with postoperative myocardial injury (relative risk, 1.8; 99% CI, 1.2 to 2.6, P < 0.001). Shorter cumulative durations (less than 30 min) were not associated with myocardial injury. Postoperative myocardial infarction and death within 30 days occurred in 26 (6%) and 17 (4%) patients with IOH as defined by a mean arterial pressure less than 60 mmHg, compared with 12 (3%; P = 0.08) and 15 (3%; P = 0.77) patients without IOH, respectively.

Conclusions: In elderly vascular surgery patients, IOH defined as a 40% decrease from the preinduction mean arterial blood pressure with a cumulative duration of more than 30 min was associated with postoperative myocardial injury.

Abstract

In a cohort study of elderly vascular surgery patients, intraoperative hypotension defined as a 40% decrease from preinduction mean arterial pressure for greater than 30 min is associated with an increased postoperative myocardial injury. The work highlights the degree and duration of perioperative hypotension as important variables associated with myocardial injury in a high-risk surgical population.

Supplemental Digital Content is available in the text.