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BJA Advance Access first published online on January 21, 2005
This version published online on April 22, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei063
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005

Postgraduate Issue Review Article

Perioperative myocardial infarction--aetiology and prevention

H.-J. Priebe 1*

1 University Hospital/Department of Anaesthesia, Hugstetter Strasse 55, D-79106 Freiburg, Germany

* To whom correspondence should be addressed.
H.-J. Priebe, E-mail: priebe{at}ana1.ukl.uni-freiburg.de


  Abstract

Perioperative myocardial infarction (PMI) is one of the most important predictors of short- and long-term morbidity and mortality associated with non-cardiac surgery. Prevention of a PMI is thus a prerequisite for an improvement in overall postoperative outcome. The aetiology of PMI is multifactorial. The perioperative period induces large, unpredictable and unphysiological alterations in coronary plaque morphology, function and progression, and may trigger a mismatch of myocardial oxygen supply and demand. With many diverse factors involved, it is unlikely that one single intervention will successfully improve cardiac outcome following non-cardiac surgery. A multifactorial, step-wise approach is indicated. Based on increasing knowledge of the nature of atherosclerotic coronary artery disease, and in view of the poor positive predictive value of non-invasive cardiac stress tests, and the considerable risk of coronary angiography and coronary revascularization in high-risk patients, the paradigm is shifting from an emphasis on extensive non-invasive preoperative risk stratification to a combination of selective non-invasive testing and aggressive pharmacological perioperative therapy. Perioperative plaque stabilization by pharmacological means may be as important in the prevention of PMI as an increase in myocardial oxygen supply or a reduction in myocardial oxygen demand.

Keywords: complications, cardiac; recovery.
This is a new version of this article updated with an Addendum.
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