Myocardial infarction in major noncardiac surgery: Epidemiology, pathophysiology and prevention
Abstract
Overview
The number of subjects undergoing major noncardiac surgery who are at risk for
perioperative myocardial infarction (MI) is growing worldwide.
It has been estimated that 500,000 to 900,000 patients suffer major perioperative cardiovascular
complications every year, with consequent heavy, long-term prognostic implications and
costs.
It is well known that perioperative MIs don’t share the same pathophysiology as nonsurgical MIs
but the relative role of the different, potential triggers has not been completely clarified.
Many aspects of the perioperative management, including risk-stratification and prophylactic or
postoperative interventions have also not been completely defined.
Throughout recent years many resources have been invested to clarify these aspects and experts
have developed indices and algorithm-based strategies to better assess the cardiac risk
and to guide the perioperative management.
The scope of the present review is to discuss the main aspects of perioperative MI in noncardiac
surgery, with particular regard to epidemiology, pathophysiology, preoperative risk stratification,
prophylaxis and therapy. (Heart International 2006; 2: 82-93)
Keywords
Myocardial infarction, Noncardiac surgery, Cardiac risk
Article Information
Correspondence
Dr. Stefano Lucreziotti, U.O. Cardiologia, Azienda Ospedaliera S. Paolo, Via di Rudinì, 8, 20142 Milano, lucre.sp@libero.it
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