Presentation on theme: "Risk For MI After Arthroplasty Present by R2 Choopong Luansritisakul R2 Jittrawan Attawattanakul Supervise by Assoc.Prof. Sirilak Suksompong."— Presentation transcript:
Risk For MI After Arthroplasty Present by R2 Choopong Luansritisakul R2 Jittrawan Attawattanakul Supervise by Assoc.Prof. Sirilak Suksompong
A 81 year-old man Admit for Elective total hip replacement Underlying disease : HT on Atenolol (50) 1x1 DLP on Simvastatin (20) 1x1 Old CVA 4year ago (full recovery) Previous MI 11 months ago Choice of anesthesia : GA with ETT Intraoperative : no complication POD 7 : typical angina, ECG CK-MB 2.7 (0-3ng/ml), Trop-T 1.78(0-0.2ng/ml) Imp NSTEMI
Acute Myocardial Infarction Definition Detection of and/or of cardiac biomarker values (preferably cardiac troponin) with > value above the 99 th percentile upper reference limit and with > one of the following : Circulation, published online August 24,2012; 2012 American Heart Association,Inc.
Symptoms of ischemia New or presumed new significant ST-T changes or new LBBB Development of pathological Q waves in ECG Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality Identification of an intracoronary thrombus by angiography or autopsy Circulation, published online August 24,2012; 2012 American Heart Association,Inc.
Strengths The nationwide population-based design Large sample size Information on matched controls Completeness of follow-up
Nationwide matched control retrospective cohort study The Danish national registries
Inclusion criteria Patients who underwent a primary THR or TKR surgery January,1998 to December, 2007 Age 18 years or older
Exclusion criteria Prior AMI within 6 weeks before
95,664 Patients THR group (n=66,524) TKR group (n=28,703) Control group (n=86,164) Control group (n=200,001) Followed up until- Death -Migration -Revision THR or TKR -End of study period -Acute myocardial infarction 437 patients excluded Thromboprophylaxis
Incidence of acute myocardial infarction Potential risk factors Age Sex History of AMI, heart failure, cerebrovascular disease Drug dispensing within 6 months
Baseline Characteristics of patients Undergoing THR and Matched control
Prophylactic therapy Adrenergic Blockers Long term should not be discontinued No study has compared prophylactic B-Blockade with short term
Prophylactic therapy Adrenergic Blockers Statins Abrupt withdrawal cause plaque destabilization Reduced perioperative and long term cardiac complication Large randomized controlled trials are still needed
Perioperative Management Correct tachycardia, hypertension, hypotension, and pain Tight hemodynamic monitoring Blood transfusion in patients with CAD and Hb<10 Coronary intervention and antithrombotic therapy
Take Home Messages New definition of AMI THR and TKR patients increased risk of AMI during the first 2 weeks after surgery Elective THR and TKR should be contraindicated in patients with previous MI in last 1 year before Management for decrease risk of postoperative MI are necessary