Perioperative Myocardial Infarction

Abstract

The risk of developing myocardial infarction (MI) in connection with surgery and anaesthesia has been recognized for at least 75 years [19, 79, 93, 101]. Since then numerous reports have been published, some describing the incidence and characteristics of perioperative myocardial infarction (PMI), others the risk factors involved. To compare these publications is difficult because of the great span in years between various studies, and the variability in study conditions such as selection and size of population, the use of a retrospective or a prospective approach, variations in postoperative care, the method of diagnosis of PMI etc. These factors can at least partly explain the variability and even contradictions observed in results. In most of these studies statistical evaluation also leaves much to be desired. The questions are often multifactorial, without the appropriate tests being performed. Performing simple chi-squared tests on whether sex, age, type or duration of anaesthesia etc, influence the infarction rate, does not provide a correct picture. There is often some co-variation between many of these factors, such as duration of anaesthesia and type of surgery. Thus the papers should be evaluated critically and the effects of a single factor reported in a single paper should be interpreted with caution. Even more impressive, therefore, are the similarities in some of the results in spite of these differences in methodology, and certain trends appear in the literature that are important to the daily work of the anaesthetist. In this review we have concentrated on the epidemiological aspects of PMI and the risk factors that have practical consequences in the treatment of patients. Frontline research concerning the pathophysiology of myocardial ischaemia and infarction and possible effects of

Treatment of acute right coronary artery occlusion during anesthesia

“…LTHOUGH occlusion of a stenosed coronary artery during operation is rare, it is a potentially dangerous complication causing myocardial infarction and circulatory collapse. 1,2 This case report describes the anesthetic management of a patient who showed intraoperative ST segment depression in leads II and V5. Diltiazem and nifedipine, but not nitroglycerine, improved the ST depression which returned to normal with a percutaneous cardiopulmonary system (PCPS).…”

Glycogen Phosphorylase Isoenzyme BB Mass Release After Coronary Artery Bypass Grafting

“…Creatine kinase isoenzyme MB catalytic concentration is of limited sensitivity and specificity in the laboratory diagnosis of perioperative myocardial ischaemia and small perioperative myocardial infarctions (8,9). Creatine kinase isoenzyme MB catalytic concentration also does not meet current needs for a highly sensitive marker of minor myocardial injury, which is necessary to compare different means of cardioprotection (10).…”

Bedeutung der Akut-PTCA in der Therapie des perioperativen Myokardinfarkts

“…Die Extrapolation nordamerikanischer Daten auf bundesdeutsche Verhältnisse läßt annehmen, daß etwa bei einem Drittel der Patienten eine nachgewiesene koronare Herzerkrankung, entsprechende Risikofaktoren oder ein Alter über 65 Jahre vorliegt [35]. Insbesondere der kürzlich vorangegangene Myokardinfarkt und die eingeschränkte linksventrikuläre Funktion wurden als bedeutende Risikofaktoren gewertet [22,63,67]. In den 50er und 60er Jahren war es Ziel der klinischen Forschung, Prädiktoren für perioperative kardiovaskuläre Komplikationen zu identifizieren.…”

“…Perioperative myocardial infarction · Acute-PTCA · Thrombolytic therapy · Cardiogenic shock nicht-kardiochirurgischen Eingriffen ein perioperatives Infarktrisiko von 0,1 bis 0,7% angenommen [22,34]. Bei Patienten mit einer gesicherten koronaren Herzkrankheit beträgt nach einer kürzlich publizierten prospektiven Studie von Badner et al das perioperative Infarktrisiko etwa 5-6% [4].…”