[Retrospective analysis of critical perioperative myocardial infarction]

Myocardial infarction, a major complication of non-cardiac surgery, impacts on perioperative morbidity and mortality.

We retrospectively reviewed the intensive care unit records and anesthesia charts of non-cardiac surgical patients needing cardiac intensive care for myocardial infarction from April 1998 to December 2000 at the University of Tokyo Hospital and analyzed data obtained from these records.

Four cases were detected. Three were vascular patients. The myocardial infarction occurred in two patients preoperatively, in one intraoperatively, and in another postoperatively. Hypovolemia was considered as an important contributing factor. All the patients developed shock abruptly and cardiac arrest followed in three. Three needed intra-aortic balloon counterpulsation, and one of these needed percutaneous cardiopulmonary support. Emergent percutaneous coronary intervention was performed in all cases and resuscitation was successful temporarily in all patients. However, the clinical outcome was poor; three died in our hospital and one transferred to another hospital became severely disabled.

Surgical patients can be asymptomatic although they have significant coronary artery disease. Most of the events occurred abruptly without preexisting myocardial ischemia, suggesting the pathophysiology causing acute coronary syndrome. Thorough cardiac examination, including coronary angiography is recommended preoperatively in patients with strong coronary risks, especially in vascular patients.