Perioperative myocardial injury and the contribution of hypotension

Area of Science:

• Anesthesiology
• Cardiology
• Critical Care Medicine

Background:

• Postoperative mortality significantly exceeds intraoperative anesthesia-related mortality.
• Myocardial injury is a primary driver of this postoperative mortality.
• Hypotension is strongly associated with myocardial injury, renal injury, and death.

Purpose of the Study:

• To investigate the relationship between hypotension and perioperative outcomes.
• To identify potential harm thresholds for hypotension in different perioperative settings.
• To explore the possibility of preventing myocardial injury by managing hypotension.

Main Methods:

• Review of existing literature and data on perioperative hypotension.
• Analysis of associations between mean arterial pressure (MAP) and adverse outcomes.
• Consideration of data from surgical, critical care, and ward settings.

Main Results:

• The harm threshold for hypotension during surgery is approximately 65 mmHg MAP.
• The threshold in critical care units is higher, around 90 mmHg MAP.
• The threshold on surgical wards is uncertain but likely intermediate.

Conclusions:

• Hypotension is a critical factor in perioperative myocardial injury and mortality.
• While confounding exists, evidence suggests intervening to limit hypotension can improve outcomes.
• Managing perioperative hypotension is a potential strategy to reduce adverse events.