Postoperative myocardial ischemic events

During the last 15 years, improved intraoperative hemodynamic management has helped reduce the incidence of myocardial ischemic events, and most events now occur outside the operating room in the first 72 hours following surgery. Currently, what is considered cost-effective management monitors high risk patients in the intensive care unit postoperatively, before transferring them to an unmonitored nursing unit. However, in both monitored and unmonitored areas ischemia is usually not appreciated unless clinical symptoms are present. Thus, our current system of delivering postoperative care is both inefficient and costly. It is clear that we are on the verge of a new frontier in our ability to detect and diagnose perioperative myocardial ischemic events. The possibility of acute real-time intervention and accurate risk stratification using surgery as a stress test is exciting. The challenge at hand is to utilize these modalities in the most beneficial, cost-effective manner. Only through continued quality research can this goal be attained.