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- Title
Characteristics and Short-Term Prognosis of Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery.
- Authors
Devereaux, P.J.; Xavier, Denis; Pogue, Janice; Guyatt, Gordon; Sigamani, Alben; Garutti, Ignacio; Leslie, Kate; Rao-Melacini, Purnima; Chrolavicius, Sue; Homer Yang; MacDonald, Colin; Avezum, Alvaro; Lanthier, Luc; Weijiang Hu; Yusuf, Salim
- 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.
- Subjects
MYOCARDIAL infarction; CARDIAC surgery; PROGNOSIS; SURGICAL complications; OPERATIVE surgery; ELECTROCARDIOGRAPHY; COHORT analysis
- Publication
Annals of Internal Medicine, 2011, Vol 154, Issue 8, p523
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/0003-4819-154-8-201104190-00003