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Myocardial infarction in major noncardiac surgery: Epidemiology, pathophysiology and prevention
Stefano Lucreziotti1, Francesca Carletti, Giulia Santaguida
1Unità Operativa di Cardiologia, Azienda Ospedaliera S. Paolo, Polo Universitario, Milano - Italy.
Insights
Major noncardiac surgery poses risks for perioperative myocardial infarction (MI). This review clarifies MI pathophysiology, risk assessment, and management strategies for at-risk surgical patients.
Area of Science:
- Cardiology
- Anesthesiology
- Perioperative Medicine
Background:
- Growing number of patients undergoing major noncardiac surgery are at risk for perioperative myocardial infarction (MI).
- An estimated 500,000 to 900,000 patients annually experience major perioperative cardiovascular complications, leading to significant long-term implications and costs.
- Perioperative MIs have distinct pathophysiology compared to non-surgical MIs, with unclear triggers.
Purpose of the Study:
- To review the epidemiology, pathophysiology, and management of perioperative myocardial infarction in noncardiac surgery.
- To discuss current risk stratification methods and prophylactic/therapeutic interventions.
- To provide insights into optimizing perioperative cardiac care.
Main Methods:
- Literature review focusing on perioperative myocardial infarction.
- Analysis of epidemiological data and pathophysiological mechanisms.
- Evaluation of risk assessment indices and management algorithms.
Main Results:
- Perioperative MI is a significant concern in noncardiac surgery, with evolving understanding of its causes.
- Various indices and strategies have been developed for risk stratification and guiding management.
- Optimal prophylactic and postoperative interventions require further definition.
Conclusions:
- A comprehensive understanding of perioperative MI is crucial for improving patient outcomes.
- Risk stratification and tailored management strategies are essential for mitigating cardiac events.
- Continued research is needed to refine perioperative cardiac care protocols.
Abstract:
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.
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