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(Chest. 2006;130:584-596.)
© 2006 American College of Chest Physicians

Management of Perioperative Myocardial Infarction in Noncardiac Surgical Patients*

Adebola O. Adesanya, MBBS, FCCP; James A. de Lemos, MD; Nancy B. Greilich, MD and Charles W. Whitten, MD

* From the Department of Anesthesiology and Pain Management (Drs. Adesanya, Greilich, and Whitten), and Department of Medicine, Division of Cardiology (Dr. de Lemos), University of Texas Southwestern Medical Center at Dallas, Dallas, TX.

Correspondence to: Adebola O. Adesanya, MD, FCCP, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; e-mail: adebola.adesanya{at}utsouthwestern.edu

Abstract

Perioperative myocardial infarction (PMI) is a major cause of morbidity and mortality in patients undergoing noncardiac surgery. The incidence of PMI varies depending on the method used for diagnosis and is likely to increase as the population ages. Studies have examined different methods for prevention of myocardial infarction (MI), including the use of perioperative ß-blockers, {alpha}2-agonists, and statin therapy. However, few studies have focused on the treatment of PMI. Current therapy for acute MI generally involves anticoagulation and antiplatelet therapy, raising the potential for surgical site hemorrhage in this population. This article reviews the possible mechanisms, diagnosis, and treatment options for MI in the surgical setting. We also suggest algorithms for treatment.

Key Words: anticoagulation • myocardial ischemia • noncardiac surgery • percutaneous coronary intervention • perioperative myocardial infarction • platelet inhibitors






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