Perioperative acute myocardial infarction increases mortality following noncardiac surgery.
OBJECTIVE
To provide insight into diagnosis, treatment, and prevention of perioperative myocardial infarction (PMI).


METHODS
The authors retrospectively analyzed PMI characteristics in patients undergoing noncardiac surgery and identified risk factors for death.


METHODS
An affiliated teaching hospital with about 1500 beds.


METHODS
The authors screened electronic medical records and retrospectively analyzed clinical data from 117,856 patients who underwent noncardiac surgery during the period from August 2003 through June 2011.


METHODS
Patients were divided into two groups based on survival at 30 days after PMI.


RESULTS
PMI was reported in 61 patients, for an overall incidence rate of 5.2 per 10,000. PMI incidence increased significantly with age, with a rate of 0.97 per 10,000 for the 45- to 60-year-old group, and increasing to a rate of 40.4 per 10,000 for the>75-year-old group (p<0.001). The mortality rate of non-PMI patients (n = 117,795) was 0.32%, whereas the mortality rate for the 61 PMI patients was 36.1% (p<0.001). PMI occurred acutely (within 48 to 72 hours of surgery) in the majority of patients (78.7%), and only 18% of these patients complained of chest pain. The majority of patients who suffered PMI had non-ST segment elevation acute myocardial infarction (78.7%). By multiple logistic regression analysis, lack of anticoagulation/antiplatelet therapy and cardiogenic shock were independent risk factors for death in PMI patients (p = 0.001 for both).


CONCLUSIONS
PMI incidence increased significantly with advanced age. PMI increased mortality following non-cardiac surgery. The independent risk factors for death in PMI patients following noncardiac surgery were lack of anticoagulation/antiplatelet therapy and cardiogenic shock.
Department of Anesthesiology and Surgical Intensive Care, the First Hospital, Peking University, Beijing, China. Electronic address: lishuangling888@hotmail.com.
Shuang-Ling
SL
Li
Dong-Xin
DX
Wang
Xin-Min
XM
Wu
Nan
N
Li
Ya-Qing
YQ
Xie
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D009206:Myocardium / Q000201:enzymology; D059035:Perioperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality; D013514:Surgical Procedures, Operative / Q000401:mortality*; D016019:Survival Analysis
D000925:Anticoagulants; D015415:Biomarkers
mortality; noncardiac surgery; perioperative acute myocardial infarction; survival