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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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Detection and management of perioperative myocardial ischemia

Bruce M Biccard1

  • 1Perioperative Research Group, Department of Anaesthetics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.

Current Opinion in Anaesthesiology
|March 28, 2014
PubMed

Insights

Most patients with myocardial injury after noncardiac surgery are asymptomatic but face significant mortality risks. New diagnostic criteria and postoperative troponin surveillance are needed for better detection and management.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Perioperative Medicine

Background:

  • Perioperative myocardial ischemia is a significant concern in noncardiac surgery.
  • Current diagnostic criteria for myocardial infarction may not be optimal in the perioperative setting.

Purpose of the Study:

  • To review current evidence on detecting and managing perioperative myocardial ischemia.
  • To advocate for the adoption of 'myocardial injury after noncardiac surgery' as a clinical entity.

Main Methods:

  • Literature review of existing evidence on perioperative myocardial ischemia.
  • Analysis of diagnostic criteria and management strategies.

Main Results:

  • Myocardial injury after noncardiac surgery (MINS) is often asymptomatic.
  • MINS is linked to increased short-term and long-term mortality from both cardiac and noncardiac causes.

Conclusions:

  • Adopt 'myocardial injury after noncardiac surgery' over nonsurgical myocardial infarction criteria for accurate prevalence assessment.
  • Investigate the feasibility of widespread postoperative troponin surveillance.
  • Urgent need for clinical trials on therapies for MINS.
Abstract

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