title: Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study.
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.
  
  
  METHODS
  Cohort study. (ClinicalTrials.gov registration number: NCT00182039)
  
  
  METHODS
  190 centers in 23 countries.
  
  
  METHODS
  8351 patients included in the POISE (PeriOperative ISchemic Evaluation) trial.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Cardiac markers were measured only until day 3 after surgery, and additional asymptomatic MIs may have been missed.
  
  
  CONCLUSIONS
  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.
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.forename: Denis
authors.initials: D
authors.lastname: Xavier
authors.forename: Janice
authors.initials: J
authors.lastname: Pogue
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.forename: Alben
authors.initials: A
authors.lastname: Sigamani
authors.forename: Ignacio
authors.initials: I
authors.lastname: Garutti
authors.forename: Kate
authors.initials: K
authors.lastname: Leslie
authors.forename: Purnima
authors.initials: P
authors.lastname: Rao-Melacini
authors.forename: Sue
authors.initials: S
authors.lastname: Chrolavicius
authors.forename: Homer
authors.initials: H
authors.lastname: Yang
authors.forename: Colin
authors.initials: C
authors.lastname: Macdonald
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
authors.forename: Luc
authors.initials: L
authors.lastname: Lanthier
authors.forename: Weijiang
authors.initials: W
authors.lastname: Hu
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D059035:Perioperative Period; D011379:Prognosis; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin; D052279:Creatine Kinase, MB Form