7. Dennis Mangano
Now,
Mangano. Mangano did a fundamental study as well. Dr. Mangano
studied 474 patients at the VA undergoing non-cardiac surgery
and found that old sick people did poorly. More specifically he
found that patients with coronary artery disease, peripheral vascular
disease, or two risk factors for coronary artery disease: age
65 or older, hypertension, diabetes, smoking, elevated cholesterol
had more events. More importantly he found that 41 percent of
them had an episode of myocardial ischemia on Holter monitoring
taken in the perioperative week. Now this 40% rate may seem a
bit high, but it is one millimeter, for one minute. It is not
the myocardial ischemia where the patient calls the nurse with
chest pain. Only 5% of this ischemia was detected by clinical
staff.
If only 5% is detected by clinical staff, is it
important? YES! A single one minute episode of myocardial ischemia
raised the risk of cardiac death, myocardial infarction, unstable
angina, congestive heart failure, or ventricular tachycardia by
a factor of 9 fold. Yikes! A single one minute episode of myocardial
ischemia increases the risk of an ischemic event 9 fold.