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Clinical Impact of Perioperative Myocardial Infarction After Pancreatic Surgery

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The aim of this study was to evaluate the incidence, clinical impact and outcome of perioperative myocardial infarction (PMI) in patients undergoing pancreatic surgery.

Methods

A data of 1,625 patients undergoing pancreatic resection were prospectively collected and analysed with regard to PMI. Demographic aspects, co-morbidities and clinical course were evaluated. Cardiac risk factors (ASA and NYHA), postoperative complications and mortality were compared in a match-pair analysis (1:3) with patients without PMI.

Results

Twenty-nine patients with PMI after pancreatic surgery were identified. PMI occurred after all types of pancreatic operations and was observed most frequently (72.2 %) within the first postoperative week. In a total of 90 %, PMI fulfilled the criteria of non-STEMI. Nearly half of the patients (48 %) were clinically asymptomatic. Both ASA III and heart failure were more frequent in patients with PMI. The in-hospital mortality was significantly increased after PMI (p < 0.002), with post-pancreatectomy haemorrhage (PPH) as the most relevant underlying risk factor.

Conclusion

PMI is a rare but severe complication after pancreatic operations, contributing significantly to in-hospital mortality. Clinical management mainly includes an anti-coagulant approach. This may be related with an increased risk for PPH. Therefore, the use of anti-coagulant drugs in the early postoperative period—especially in asymptomatic patients—should be critically evaluated.

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Abbreviations

ASA:

Physical status classification system of American Society of Anesthesiologists

ASS:

Acetylsalicylic acid

ECG:

Electrocardiography

hsTNT:

Highly-sensitive cardiac troponin T

ISGPF:

International study group of pancreatic fistula

ISGPS:

International Study Group of Pancreatic Surgery

NSTEMI:

Non-ST-elevated myocardial infarction

NYHA:

New York Heart Association functional classification

PDAC:

Pancreatic ductal adenocarcinoma

PMI:

Perioperative myocardial infarction

POPF:

Postoperative pancreatic fistula

PPH:

Postpancreatectomy haemorrhage

STEMI:

ST-elevated myocardial infarction

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Competing interests

The authors declare that they have no competing interests. All authors are employed by the University Hospital of Heidelberg, Germany.

Authors’ contributions

DD conceived of the study, participated in its design and coordination, acquired the study data and drafted the manuscript, TH participated in study design and has been involved in drafting the manuscript, JK participated in the design of the study and acquired the study data, UH performed the statistical analysis, JR, SH and MB participated in the design of the study and revised critically the manuscript, JW participated in the overall design, study coordination and has given final approval of the version. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Dmitriy I. Dovzhanskiy, Thilo Hackert, Jens Krumm, Ulf Hinz, Markus W. Büchler & Jens Werner

  2. Departments of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Jens Roggenbach & Stefan Hofer

Authors
  1. Dmitriy I. Dovzhanskiy
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  2. Thilo Hackert
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  3. Jens Krumm
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  4. Ulf Hinz
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  5. Jens Roggenbach
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  6. Stefan Hofer
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  7. Markus W. Büchler
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  8. Jens Werner
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Corresponding author

Correspondence to Jens Werner.

Additional information

Dmitriy I. Dovzhanskiy and Thilo Hackert contributed equally to this work.

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Dovzhanskiy, D.I., Hackert, T., Krumm, J. et al. Clinical Impact of Perioperative Myocardial Infarction After Pancreatic Surgery. J Gastrointest Surg 18, 929–934 (2014). https://doi.org/10.1007/s11605-014-2453-0

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  • DOI: https://doi.org/10.1007/s11605-014-2453-0

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