Patients undergoing cardiac and high-risk noncardiac surgery have a high incidence of perioperative myocardial infarction. The early diagnosis of perioperative myocardial injury in these patients is complicated. In the perioperative period, there is a high incidence of nonspecific electrocardiographic changes and cardiac biomarker release. It is becoming increasingly imortant to differentiate myocardial necrosis from nonspecific changes because of the need for early intervention and the poential long term implications of a perioperative myocardial event. Although sensitive and specific assays to assess myoardial damage have been developed, specific thresholds to establish the occurrence a significant perioperative event have not been firmly defined. This review will attempt to outline the current evidence supporting the use of clinical symptoms, electrocardiographic changes, and cardiac biomarkers in the diagnosis of perioperative myocardial infarction and the longerm implication of these findings.
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References
1.
1. Yeager RA, Moneta GL, Edwards JM, et al: Late survival after perioperative myocardial infarction complicating vasular surgery. J Vasc Surg20:598-604, 1994.
2.
2. Klatte K, Chaitman BR, Theroux P, et al: Increased mortalty after coronary artery bypass graft surgery is associated with increased levels of postoperative creatine kinase-mycardial band isoenzyme release: Results from the GUARDIAN trial. J Am Coll Cardiol38:1070-1077, 2001.
3.
3. Lopez-Jimenez F, Goldman L, Sacks DB, et al: Prognostic value of cardiac troponin T after noncardiac surgery: 6onth follow-up data. J Am Coll Cardiol29:1241-1245, 1997.
4.
4. Mangano DT, Browner WS, Hollenberg M, et al: Long-term cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group. JAMA268:233-239, 1992.
5.
5. Jain U, Laflamme CJ, Aggarwal A, et al: Electrocardioraphic and hemodynamic changes and their association with myocardial infarction during coronary artery bypass surgery. A multicenter study. Multicenter Study of Perioperative Ischemia (McSPI) Research Group. Anesthesiology86:576-591, 1997.
6.
6. Mangano DT: Cardiovascular morbidity and CABG surgery a perspective: Epidemiology, costs, and potential therapeutic solutions. J Card Surg10:366-368, 1995.
7.
7. Greaves SC, Rutherford JD, Aranki SF, et al: Current incience and determinants of perioperative myocardial inarction in coronary artery surgery. Am Heart J132:572-578, 1996.
8.
8. Eagle KA, Berger PB, Calkins H, et al: ACC/AHA guideline update for perioperative cardiovascular evaluation for nonardiac surgery-executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol39:542-553, 2002.
9.
9. Rao TL, Jacobs KH, El-Etr AA: Reinfarction following aneshesia in patients with myocardial infarction. Anesthesiology59:499-505, 1983.
10.
10. Mangano DT, Browner WS, Hollenberg M, et al: Association of perioperative myocardial ischemia with cariac morbidity and mortality in men undergoing noncariac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med323:1781-1788, 1990.
11.
11. Sprung J, Abdelmalak B, Gottlieb A, et al: Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery. Anesthesiology93:129-140, 2000.
12.
12. Badner NH, Knill RL, Brown JE, et al. Myocardial infarction after noncardiac surgery. Anesthesiology88:572-578, 1998.
13.
13. Landesberg G, Mosseri M, Zahger D, et al: Myocardial inarction after vascular surgery: The role of prolonged stress-induced, ST depression-type ischemia. J Am Coll Cardiol37:1839-1845, 2001.
14.
14. Landesberg G, Einav S, Christopherson R, et al: Periperative ischemia and cardiac complications in major vasular surgery: Importance of the preoperative twelve-lead electrocardiogram. J Vasc Surg26:570-578, 1997.
15.
15. Fleisher LA, Nelson AH, Rosenbaum SH: Postoperative mycardial ischemia: Etiology of cardiac morbidity or maniestation of underlying disease?J Clin Anesth7:97-102, 1995.
16.
16. Kannel WB, Abbott RD: Incidence and prognosis of unrecgnized myocardial infarction. An update on the Framingham study. N Engl J Med311:1144-1147, 1984.
17.
17. Charlson ME, MacKenzie CR, Ales K, et al: Surveillance for postoperative myocardial infarction after noncardiac opertions. Surg Gynecol Obstet167:407-414, 1988.
19. Breslow MJ, Miller CF, Parker SD, et al: Changes in T-wave morphology following anesthesia and surgery: A common recovery-room phenomenon. Anesthesiology64:398-402, 1986.
20.
20. Jain U: Electrocardiographic determination of perioperaive myocardial ischemia and stunning. J Card Surg9:413-416, 1994.
21.
21. Benoit MO, Paris M, Silleran J, et al: Cardiac troponin I: Its contribution to the diagnosis of perioperative myocardial infarction and various complications of cardiac surgery. Crit Care Med29:1880-1886, 2001.
22.
22. Fleisher LA, Zielski MM, Schulman SP: Perioperative STegment depression is rare and may not indicate myocarial ischemia in moderate-risk patients undergoing nonardiac surgery. J Cardiothorac Vasc Anesth11:155-159, 1997.
23.
23. Adams JE 3rd, Sicard GA, Allen BT, et al: Diagnosis of peioperative myocardial infarction with measurement of cariac troponin I. N Engl J Med330:670-674, 1994.
24.
24. Liebson PR, Klein LW: The non-Q wave myocardial infarcion revisited: 10 years later. Prog Cardiovasc Dis39:399-444, 1997.
25.
25. Landesberg G, Luria MH, Cotev S, et al: Importance of long-duration postoperative ST-segment depression in cariac morbidity after vascular surgery. Lancet341:715-719, 1993.
26.
26. Pasternack PF, Grossi EA, Baumann FG, et al: The value of silent myocardial ischemia monitoring in the prediction of perioperative myocardial infarction in patients undergoing peripheral vascular surgery. J Vasc Surg10:617-625, 1989.
27.
27. Ouyang P, Gerstenblith G, Furman WR, et al: Frequency and significance of early postoperative silent myocardial ischemia in patients having peripheral vascular surgery. Am J Cardiol64:1113-1116, 1989.
29. Graeber GM, Clagett GP, Wolf RE, et al. Alterations in serum creatine kinase and lactate dehydrogenase. Association with abdominal aortic surgery, myocardial inarction and bowel necrosis. Chest97:521-527, 1990.
30.
30. Metzler H, Gries M, Rehak P, et al: Perioperative myocarial cell injury: The role of troponins. Br J Anaesth78:386-390, 1997.
31.
31. Lee TH, Thomas EJ, Ludwig LE, et al: Troponin T as a marker for myocardial ischemia in patients undergoing major noncardiac surgery. Am J Cardiol77:1031-1036, 1996.
32.
32. Bonnefoy E, Filley S, Kirkorian G, et al: Troponin I, troonin T, or creatine kinase-MB to detect perioperative mycardial damage after coronary artery bypass surgery. Chest114:482-486, 1998.
33.
33. Van de Werf F: Cardiac troponins in acute coronary synromes. N Engl J Med335:1388-1389, 1996.
34.
34. Mair J, Larue C, Mair P, et al: Use of cardiac troponin I to diagnose perioperative myocardial infarction in coronary artery bypass grafting. Clin Chem40:2066-2070, 1994.
35.
35. Carrier M, Pellerin M, Perrault LP, et al: Troponin levels in patients with myocardial infarction after coronary artery bypass grafting. Ann Thorac Surg69:435-440, 2000.
36.
36. Sadony V, Korber M, Albes G, et al: Cardiac troponin I plasa levels for diagnosis and quantitation of perioperative myocardial damage in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg13:57-65, 1998.
37.
37. Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol36:959-969, 2000.
38.
38. Califf RM, Abdelmeguid AE, Kuntz RE, et al: Myonecrosis after revascularization procedures. J Am Coll Cardiol31:241-251, 1998.
39.
39. Costa MA, Carere RG, Lichtenstein SV, et al: Incidence, predictors, and significance of abnormal cardiac enzyme rise in patients treated with bypass surgery in the arterial revascularization therapies study (ARTS). Circulation104:2689-2693, 2001.
40.
40. Holmvang L, Jurlander B, Rasmussen C, et al: Use of biohemical markers of infarction for diagnosing perioperaive myocardial infarction and early graft occlusion after coronary artery bypass surgery. Chest121:103-111, 2002.
41.
41. Poldermans D, Boersma E, Bax JJ, et al: The effect of bisorolol on perioperative mortality and myocardial infarcion in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med341:1789-1794, 1999.
