Incidence of thrombosis in perioperative and non-operative myocardial infarction

Abstract

Thrombosis was less common in perioperative than non-operative MI, despite similar underlying plaque morphology.

Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery

“…The failure of DAPT to offer protection from perioperative myocardial injury may reflect differing mechanisms of perioperative myocardial injury and non-operative MI, which was demonstrated in a study using optical coherence tomography in patients with MI during surgery. 32 OBTAIN included patients who had undergone PCI up to 4 yr before surgery. Whilst current guidelines recommend DAPT for up to a year after PCI, late in-stent thrombosis has been Table 3 Association between antiplatelet therapy, bleeding, and major adverse cardiovascular events (MACE); unadjusted analysis.…”

The emergence of a postoperative myocardial injury epidemic: true or false?

“…Postoperative myocardial infarctions are predominately type 2 or non-ST elevation myocardial infarctions 9,46,47 and comprise 20-30% of all postoperative myocardial injuries. The patients with multiple complications that also include myocardial injury have been shown, in at least two independent studies, to have the highest in-hospital mortality (up to 30%).…”

Preoperative Cardiac Risk Assessment

“…25,26 The mechanism of MINS likely involves both supplyedemand mismatch from CAD and ischemia secondary to obstructive CAD. 27 Other causes of myocardial ischemia after surgery such as sepsis, pulmonary embolism, or cardioversion are not included in the definition of MINS. 25 MINS is an important marker for mortality after noncardiac surgery.…”

“…Although coronary computed tomographic angiography is less invasive than angiography, it was found to overestimate risk in the Vascular Events in Noncardiac Surgery Patients Cohort, and it is not recommended for perioperative risk stratification. [1][2][3]27 LABORATORY TESTING BNP or NT-proBNP American guidelines recommend preoperative NT-proBNP for diagnosing or optimizing heart failure. 1 European guidelines state that BNP and NT-proBNP measurements can be considered to obtain additional independent prognostic information in high-risk patients undergoing surgery.…”