BACKGROUND: The study of the pathophysiologic mechanism of perioperative myocardial infarctions is limited to two small autopsy studies suggesting a major role for plaque rupture and thrombosis. However, the perioperative period is characterized by increased cardiac metabolic demand that may lead to infarction in patients with otherwise stable obstructive coronary artery disease. The purpose of this study is to investigate the pathophysiology of perioperative myocardial infarctions. METHODS: Hospital records and coronary angiograms from patients from 1998 to 2006 who underwent noncardiac surgery complicated by a perioperative myocardial infarction (MI) were reviewed. The culprit lesion was identified based on ECG, left ventriculography, and coronary angiography. Degree of stenosis, TIMI flow, ACC thrombus grade, calcification score, and lesion morphology were evaluated. Based on these criteria, MIs were categorized as thrombotic, demand, or nonobstructive. RESULTS: Sixty-six patients (average age, 71 years and 44% male), 77% of whom underwent an intermediate risk surgery with a 2% perioperative mortality, were identified. The distribution of demand, thrombotic, and nonobstructive MI was 55%, 26%, and 19%, respectively. There was neither statistical difference in the occurrence of prolonged hypotension or tachycardia between groups nor was there any difference in the use of antiplatelets, β-blockers, or statins. CONCLUSION: This study identified demand ischemia as the predominant etiology of perioperative MIs in this cohort. An improved understanding of the pathophysiologic mechanism of perioperative MIs may facilitate the evaluation and management of preoperative patients.
BACKGROUND: The study of the pathophysiologic mechanism of perioperative myocardial infarctions is limited to two small autopsy studies suggesting a major role for plaque rupture and thrombosis. However, the perioperative period is characterized by increased cardiac metabolic demand that may lead to infarction in patients with otherwise stable obstructive coronary artery disease. The purpose of this study is to investigate the pathophysiology of perioperative myocardial infarctions. METHODS: Hospital records and coronary angiograms from patients from 1998 to 2006 who underwent noncardiac surgery complicated by a perioperative myocardial infarction (MI) were reviewed. The culprit lesion was identified based on ECG, left ventriculography, and coronary angiography. Degree of stenosis, TIMI flow, ACC thrombus grade, calcification score, and lesion morphology were evaluated. Based on these criteria, MIs were categorized as thrombotic, demand, or nonobstructive. RESULTS: Sixty-six patients (average age, 71 years and 44% male), 77% of whom underwent an intermediate risk surgery with a 2% perioperative mortality, were identified. The distribution of demand, thrombotic, and nonobstructive MI was 55%, 26%, and 19%, respectively. There was neither statistical difference in the occurrence of prolonged hypotension or tachycardia between groups nor was there any difference in the use of antiplatelets, β-blockers, or statins. CONCLUSION: This study identified demand ischemia as the predominant etiology of perioperative MIs in this cohort. An improved understanding of the pathophysiologic mechanism of perioperative MIs may facilitate the evaluation and management of preoperative patients.
Authors: Flavia K Borges; Tej Sheth; Ameen Patel; Maura Marcucci; Terence Yung; Thomas Langer; Carolina Alboim; Carisi Anne Polanczyk; Federico Germini; Andre Ferreira Azeredo-da-Silva; Erin Sloan; Kendeep Kaila; Ron Ree; Alessandra Bertoletti; Maria Cristina Vedovati; Antonio Galzerano; Jessica Spence; P J Devereaux Journal: CJC Open Date: 2020-07-17
Authors: Mohammad A Helwani; Amit Amin; Paul Lavigne; Srikar Rao; Shari Oesterreich; Eslam Samaha; Jamie C Brown; Peter Nagele Journal: Anesthesiology Date: 2018-06 Impact factor: 7.892
Authors: Nicholas J Douville; Ida Surakka; Aleda Leis; Christopher B Douville; Whitney E Hornsby; Chad M Brummett; Sachin Kheterpal; Cristen J Willer; Milo Engoren; Michael R Mathis Journal: Circ Genom Precis Med Date: 2020-06-09
Authors: Tej Sheth; Matthew Chan; Craig Butler; Benjamin Chow; Vikas Tandon; Peter Nagele; Ayesha Mitha; Marko Mrkobrada; Wojciech Szczeklik; Yang Faridah; Bruce Biccard; Lori K Stewart; Diane Heels-Ansdell; P J Devereaux Journal: BMJ Date: 2015-04-22
Authors: Grant W Reed; Samuel Horr; Laura Young; Joshua Clevenger; Umair Malik; Stephen G Ellis; A Michael Lincoff; Steven E Nissen; Venu Menon Journal: J Am Heart Assoc Date: 2017-06-06 Impact factor: 5.501