Perioperative MI Common and Usually Asymptomatic

Mortality rates elevated and similar in those who have a perioperative myocardial infarction

WEDNESDAY, April 20 (HealthDay News) -- Perioperative myocardial infarction (MI) after noncardiac surgery is the most common major vascular complication, with most patients not experiencing ischemic symptoms, according to a study published in the April 19 issue of the Annals of Internal Medicine.

Philip J. Devereaux, M.D., Ph.D., from the McMaster University in Hamilton, Canada, and colleagues examined the characteristics and short-term outcomes of perioperative MI in 8,351 patients from the PeriOperative Ischemic Evaluation (POISE) trial who underwent noncardiac surgery. Perioperative MI was identified by either autopsy findings of acute MI or by raised levels of any of the four cardiac biomarkers or enzyme assays measured within three days of surgery, as well as at least one of the following features: symptoms of ischemia, pathologic Q wave development or ischemic changes on electrocardiography, coronary artery intervention, or MI evidence on cardiac imaging.

The investigators found that 5.0 percent of patients had perioperative MI within 30 days of enrollment in the POISE trial, 74.1 percent of which occurred within 48 hours of surgery. A total of 65.3 percent of the patients had no ischemic symptoms. The 30-day mortality rate was 11.6 and 2.2 percent in patients who had a perioperative MI and those who did not, respectively. Mortality rates were elevated and similar in patients with a perioperative MI regardless of whether they had or did not have ischemic symptoms (adjusted odds ratio, 4.76 and 4.00, respectively).

"Most patients who have a perioperative MI will not experience ischemic symptoms, and physicians should therefore require perioperative troponin monitoring to avoid missing these prognostically important MIs," the authors write.

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