[Perioperative myocardial ischemia : Current aspects and concepts]

Area of Science:

• Cardiology
• Geriatric Medicine
• Anesthesiology

Background:

• Major surgical procedures are increasingly common in older patients with comorbidities.
• Perioperative cardiovascular events, including myocardial infarction, contribute to significant morbidity and mortality.
• Myocardial injury after non-cardiac surgery (MINS) is an underrecognized complication with substantial mortality risk.

Purpose of the Study:

• To review current knowledge on perioperative myocardial infarction (PMI) and MINS.
• To highlight the prognostic significance of MINS, as demonstrated by the VISION trials.
• To propose a framework for diagnosing and managing patients at risk for these events.

Main Methods:

• Literature review of current knowledge on PMI and MINS.
• Analysis of findings from large observational trials, such as VISION 1 and VISION 2.
• Synthesis of diagnostic and therapeutic strategies for perioperative cardiovascular risk.

Main Results:

• Subtle elevations in troponin T after non-cardiac surgery are associated with increased mortality.
• MINS, though less recognized than PMI, carries a significant mortality risk.
• Existing diagnostic and therapeutic approaches require refinement for optimal patient guidance.

Conclusions:

• MINS is a critical, underappreciated complication following non-cardiac surgery.
• A structured diagnostic and therapeutic approach is needed to manage at-risk patients.
• Further research and clinical attention to MINS are essential for improving perioperative care and patient outcomes.