Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study.

Abstract:

BACKGROUND:Each year, millions of patients worldwide have a perioperative myocardial infarction (MI) after noncardiac surgery. OBJECTIVE:To examine the characteristics and short-term outcome of perioperative MI. DESIGN:Cohort study. (ClinicalTrials.gov registration number: NCT00182039) SETTING:190 centers in 23 countries. PATIENTS:8351 patients included in the POISE (PeriOperative ISchemic Evaluation) trial. MEASUREMENTS:Four cardiac biomarker or enzyme assays were measured within 3 days of surgery. The definition of perioperative MI included either autopsy findings of acute MI or an elevated level of a cardiac biomarker or enzyme and at least 1 of the following defining features: ischemic symptoms, development of pathologic Q waves, ischemic changes on electrocardiography, coronary artery intervention, or cardiac imaging evidence of MI. RESULTS:Within 30 days of random assignment, 415 patients (5.0%) had a perioperative MI. Most MIs (74.1%) occurred within 48 hours of surgery; 65.3% of patients did not experience ischemic symptoms. The 30-day mortality rate was 11.6% (48 of 415 patients) among patients who had a perioperative MI and 2.2% (178 of 7936 patients) among those who did not (P < 0.001). Among patients with a perioperative MI, mortality rates were elevated and similar between those with (9.7%; adjusted odds ratio, 4.76 [95% CI, 2.68 to 8.43]) and without (12.5%; adjusted odds ratio, 4.00 [CI, 2.65 to 6.06]) ischemic symptoms. LIMITATION:Cardiac markers were measured only until day 3 after surgery, and additional asymptomatic MIs may have been missed. CONCLUSION:Most patients with a perioperative MI will not experience ischemic symptoms. Data suggest that routine monitoring of troponin levels in at-risk patients is needed after surgery to detect most MIs, which have an equally poor prognosis regardless of whether they are symptomatic or asymptomatic.

journal_name

Ann Intern Med

authors

Devereaux PJ,Xavier D,Pogue J,Guyatt G,Sigamani A,Garutti I,Leslie K,Rao-Melacini P,Chrolavicius S,Yang H,Macdonald C,Avezum A,Lanthier L,Hu W,Yusuf S,POISE (PeriOperative ISchemic Evaluation) Investigators.

doi

10.7326/0003-4819-154-8-201104190-00003

subject

Has Abstract

pub_date

2011-04-19 00:00:00

pages

523-8

issue

8

eissn

0003-4819

issn

1539-3704

pii

154/8/523

journal_volume

154

pub_type

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