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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
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.
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.
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.