title: When is the risk acceptable to proceed to noncardiac surgery following an acute myocardial infarction?
abstract: There is a large degree of uncertainty regarding the optimal time delay between an acute (≤ 7 days) or recent (8-30 days) myocardial infarction and a patient undergoing scheduled, noncardiac surgery. Historically, the re-infarction rate for patients undergoing non-cardiac surgery within three months of a myocardial infarction has been 5%, with a very high associated mortality rate. The American Heart Association has suggested that non-cardiac surgery is acceptable six weeks after a myocardial infarction. This review considers the pathophysiology of resolution, the therapeutic responses to acute myocardial infarctions and the predictors of outcome, which may assist with the risk-benefit analysis concerning an appropriate time to proceed with non-cardiac surgery following an acute myocardial infarction. These predictors include the presence of cardiac failure, as evaluated clinically by cardiac echocardiography and increases in B-type natriuretic proteins, and the presence of persistent ischemia, as evaluated by elevations in troponin levels and ST-segment depression.
authors.affiliation: Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Semark
authors.forename: R N
authors.initials: RN
authors.lastname: Rodseth
authors.forename: B M
authors.initials: BM
authors.lastname: Biccard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D015415:Biomarkers; D003289:Convalescence; D017558:Elective Surgical Procedures; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012008:Recurrence; D012306:Risk; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling; D055815:Young Adult
chemical_list: D015415:Biomarkers