Myocardial ischemia correlates with reduced fibrinolytic activity following peripheral vascular surgery

Study Objectives: To evaluate the relationship between perioperative ischem ia and serial concentrations of D-dimer, which is a sensitive and specific marker of fibrinolytic activity. Myocardial ischemia and infarction are wel l-recognized complications of peripheral vascular surgery. We hypothesized that patients at increased risk of perioperative myocardial ischemia might be identified preoperatively by abnormal hemostatic indices. Design: Prospective clinical outcomes study. Setting: A 1,124-bed tertiary care medical center: Patients: 42 ASA physical status II, III, and IV patients undergoing periph eral vascular surgery. Interventions: Serial D-dimer concentrations were measured preoperatively, and at 24 and 72 hours postoperatively. Continuous 12-lead ST-segment monit oring (Mortara Instrument, Inc., Milwaukee, WI) was performed with the acqu isition of a 12-lead ECG every 20 seconds for 72 hours. Measurements and Main Results: D-dimer measurements were performed in dupli cate using the Dimer Cold assay (American Diagnostica, Greenwich CT). Ische mic episodes, as defined by continuous 12-lead ST-segment monitoring, occur red in 49% of patients. There were no demographic differences between ische mic and nonischemic groups. Although baseline D-dimer concentrations were n ot statistically significantly different between groups, patients experienc ing perioperative myocardial ischemia generated significantly less D-dimer during the perioperative period (p = 0.014). Conclusions: Patients with an impaired fibrinolytic response, as defined by reduced generation of D-dimer, experienced an increased incidence of perio perative myocardial ischemia. (C) 2000 by Elsevier Science Inc.