Perioperative acute myocardial infarction rate in chronic renal disease patients undergoing orthopedic surgery: Is there any difference between dialyzed and nondialyzed patients?

Thung-Lip Lee,Ying-Ying Lo,Yao-Chun Hsu,Yuan-Kun Tu,Feng-Chen Kao,Jianzhong Sun

doi:10.1371/journal.pone.0210554

Abstract

BackgroundThe incidence of acute myocardial infarction (AMI) in healthy patients undergoing noncardiac surgery is <1%. When patients with chronic kidney disease (CKD) undergo orthopedic surgery, AMI incidence can be expected to be relatively high. However, data on a population-wide scale is lacking.ObjectiveTo investigate AMI incidence in patients with CKD (with and without dialysis) undergoing orthopedic surgery.DesignA population-based study covering the period from January 1, 1997, to December 31, 2011.SettingData from the Taiwan National Health Insurance Research Database.ParticipantsParticipants were 219,195 patients with CKD who underwent surgery between January 1, 1997, and December 31, 2011.ResultsAMI occurred in 2,708 participants (1.24%). The AMI incidence rate in the dialyzed group was 1.52%, which was higher than that in the nondialyzed group after propensity score matching. Dialysis (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.62–1.98), male (OR: 1.42; 95% CI: 1.28–1.57), diabetes mellitus (OR: 1.61; 95% CI: 1.44–1.80), hyperlipidemia (OR: 1.88; 95% CI: 1.68–2.11), old myocardial infarction (OR: 18.87; 95% CI: 16.26–1.21.90), and cerebral vascular disease (CVA) (OR: 1.29; 95% CI: 1.30–1.47) were all associated with AMI in the patients with CKD.ConclusionsThe AMI risk was higher in the patients with CKD undergoing orthopedic surgery than in the general population, and the dialyzed group had a higher risk of AMI than did the nondialyzed group.

Highlights

Acute myocardial infarction (AMI), commonly known as heart attack, is a major cause of morbidity and mortality worldwide
Dialysis, male (OR: 1.42; 95% confidence intervals (CIs): 1.28–1.57), diabetes mellitus (OR: 1.61; 95% CI: 1.44–1.80), hyperlipidemia (OR: 1.88; 95% CI: 1.68–2.11), old myocardial infarction (OR: 18.87; 95% CI: 16.26– 1.21.90), and cerebral vascular disease (CVA) (OR: 1.29; 95% CI: 1.30–1.47) were all associated with acute myocardial infarction (AMI) in the patients with chronic kidney disease (CKD)
The AMI risk was higher in the patients with CKD undergoing orthopedic surgery than in the general population, and the dialyzed group had a higher risk of AMI than did the nondialyzed group

Summary

Introduction

Acute myocardial infarction (AMI), commonly known as heart attack, is a major cause of morbidity and mortality worldwide. Typical symptoms include sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a sense of impending doom) [1]. A quarter of all AMI cases are “silent” (without chest pain or other symptoms). When AMI occurs in patients undergoing surgery, symptoms are “silent” and difficult to detect. Despite advances in medical technology, cardiovascular complications, such as AMI, are still a major contributor to mortality after noncardiac surgery [3]. The incidence of acute myocardial infarction (AMI) in healthy patients undergoing noncardiac surgery is

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