Causes of perioperative myocardial infarction: their identification and prevention.

Despite major technical advances in coronary bypass surgery and myocardial preservation, perioperative infarction remains a serious problem. The authors review the pathogenesis of the two different types of myocardial injury, occlusion necrosis and reperfusion necrosis. These two entities can be distinguished clinically by radioisotope scanning. Experimental studies have demonstrated that reperfusion necrosis can be prevented pharmacologically. Since the majority of perioperative infarcts are probably due to reperfusion, the importance of distinguishing between these two entities is evident.