Perioperative myocardial infarction

The proportion of elderly patients with significant cardiac comorbidities undergoing noncardiac operations is likely to increase in the future. A perioperative myocardial infarction is associated with high in-hospital mortality and poor long-term outcomes. The majority of these events are clinically and electrocardiographically silent requiring active surveillance with cardiac biomarkers (preferably troponins). Most myocardial infarctions in the perioperative period result from a mismatch between oxygen supply and demand in patients with stable coronary artery disease. Most of the research in the field has been focused on risk stratification and prevention prior to the noncardiac operation with little emphasis in best treatment strategies after the event has occurred. Clinical trials are needed to define the role of adjunct pharmacology and cardiac imaging, including angiography, in this special population.