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Myocardial infarction after noncardiac surgery

N H Badner1, R L Knill, J E Brown

  • 1Department of Anesthesia, University Campus London Health Sciences Centre, Ontario, Canada. nbadner@julian.uwo.ca

Anesthesiology
|April 2, 1998
PubMed
Summary

Postoperative myocardial infarction (PMI) is an early event after noncardiac surgery, often occurring without chest pain. This study highlights that PMI is typically non-Q wave in nature.

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Area of Science:

  • Cardiology
  • Perioperative Medicine
  • Biomarker Research

Background:

  • Patients undergoing noncardiac surgery are at risk for postoperative myocardial infarction (PMI).
  • Intensive monitoring of cardiac isoenzymes and electric activity is crucial in the early postoperative period.

Purpose of the Study:

  • To investigate the incidence, timing, and clinical presentation of PMI in patients at risk after noncardiac surgery.
  • To characterize the electrocardiographic findings associated with PMI.

Main Methods:

  • Prospective, blinded study of 323 patients (≥50 years) with ischemic heart disease undergoing noncardiac surgery.
  • Daily clinical assessments, ECGs, and serial measurements of creatine kinase (CK), CK-2, and Troponin-T for 7 days post-operation.
  • Defined PMI based on elevated total CK and specific criteria for CK-2, ECG changes, Troponin-T levels, or pyrophosphate scan results.

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Main Results:

  • PMI occurred in 5.6% of patients (18/323), with 17% of these cases being fatal.
  • Only 3 of 18 patients with PMI reported chest pain; 56% presented with other clinical findings.
  • PMI was predominantly non-Q wave (10/18), occurring early (within 2 days) in most cases.

Conclusions:

  • Postoperative myocardial infarction is an early complication following noncardiac surgery.
  • Clinical presentation of PMI is often atypical, with chest pain being infrequent.
  • Non-Q wave myocardial infarction is the most common type observed in this high-risk population.