The pathophysiology of peri-operative myocardial infarction.
It is generally believed that plaque rupture and myocardial oxygen supply-demand imbalance contribute approximately equally to the burden of peri-operative myocardial infarction. This review critically analyses data of post-mortem, pre-operative coronary angiography, troponin surveillance, other pre-operative non-invasive investigations, and peri-operative haemodynamic predictors of myocardial ischaemia and/or myocardial infarction. The current evidence suggests that myocardial oxygen supply-demand imbalance predominates in the early postoperative period. It is likely that flow stagnation and thrombus formation is an important pathway in the development of a peri-operative myocardial infarction, in addition to the more commonly recognised role of peri-operative tachycardia. Research and therapeutic interventions should be focused on the prediction and therapy of flow stagnation and thrombus formation. Plaque rupture appears to be a more random event, distributed over the entire peri-operative admission.
Biccard
B M
BM
Department of Anaesthetics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, South Africa. biccardb@ukzn.ac.za
Rodseth
R N
RN
D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology*; D017202:Myocardial Ischemia / Q000175:diagnosis; D011183:Postoperative Complications / Q000503:physiopathology*; D011300:Preoperative Care / Q000379:methods; D014336:Troponin / Q000097:blood
D015415:Biomarkers; D014336:Troponin