Association of Perioperative Myocardial Ischemia with Cardiac Morbidity and Mortality in Men Undergoing Noncardiac Surgery

Abstract

In high-risk patients undergoing noncardiac surgery, early postoperative myocardial ischemia is an important correlate of adverse cardiac outcomes.

An overview of quality and safety in health care

“…17 In older patients with comorbidities, mortality may well be higher than has sometimes been appreciated, 18,19 and it may be influenced not only by the conduct of anesthesia but also by the management of the entire perioperative period. 19,20 Mortality and morbidity attributable to anesthesia Given the central importance of safety in anesthesia, it is disappointing that, with the arguable exception of Australia and (recently) New Zealand, 13,21 we lack data to define unequivocally the mortality associated with anesthesia today and its progress over time. The available data typically relate to only the first 24 or 48 hr after surgery.…”

“…17 Chez les patients âgés qui présentent des comorbidités, la mortalité pourrait être plus importante que ce que l'on entend parfois, 18,19 et elle pourrait être influencée non seulement par le déroulement de l'anesthésie mais aussi par la prise en charge de toute la période périopératoire. 19,20 La mortalité et la morbidité attribuables à l'anesthésie É tant donné l'importance capitale de la sécurité en anesthésie, il est décevant de noter que, à l'exception contestable de l'Australie et de la Nouvelle-Zélande (récemment), 13,21 nous manquons de données définissant sans équivoque possible la mortalité associée à l'anesthésie aujourd'hui et son évolution au fil du temps. Traditionnellement, les données disponibles ne traitent que des premières 24 ou 48 heures postopératoires.…”

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

“…In a retrospective study 15 performed on 869 patients who underwent major non-cardiac surgery, troponin I elevations (> 0.4 g/l) were observed among 38% of patients with significant intraoperative events such as hypotension, hypertension or unexpected blood loss or readmitted to the intensive care unit for an acute event on the ward. The overall frequency of MI in the whole surgical population may appear low (< 1%), but the prevalence is particularly concentrated among patients who undergo major thoracic, abdominal or vascular surgery, especially when they are ≥ 70 years [16][17][18] , and among patients with underlying coronary artery disease (CAD). In particular, the risk of perioperative MI or cardiac death is < 1% for patients who do not have CAD 19 , but increases twice in the presence of known or suspected coronary or atherosclerotic vascular disease [19][20][21][22][23][24][25] .…”

“…The onset of postoperative inflammatory reaction seems to play a role in the occurrence of MI in the following postoperative days. In particular, the inflammatory activation may be responsible for fluid shifts 16,23,49 , for the creation of a hypercoagulable environment, and for functional alterations in distant organs. Major surgery and, in particular, abdominal aortic surgery are followed by extensive changes in the plasma levels of coagulation factors and in thromboelastographic parameters leading to a hypercoagulable state.…”

New practice guidelines for perioperative beta blockade from the United States and Europe: incremental progress or a necessary evil?

“…Other data suggests treatment may be beneficial in select patient groups. [48][49][50][51][52] Yet, provocative testing that induces ischemia remains a routine part of cardiology practice, and ischemic preconditioning and now postconditioning are recognized forms of cardioprotection. Connecting the dots regarding diagnosis, detection, and appropriate treatment remains unfeasible conceptually and practically.…”