title: Perioperative Myocardial Infarction in Non-Cardiac Surgery Patients: A Prospective Observational Study.
abstract: OBJECTIVE
  Perioperative myocardial infarction is an underdiagnosed complication causing morbidity, mortality, and considerable costs. However, evidence of preventive and therapeutic options is scarce. We investigated the incidence and outcome of perioperative myocardial infarction in non-cardiac surgery patients in order to define a target population for future interventional trials.
  
  
  METHODS
  We conducted a prospective single-center study on non-cardiac surgery patients aged 50 years or older. High-sensitivity troponin T and electrocardiograph were obtained five times perioperatively. Perioperative myocardial infarction diagnosis required a significant troponin T release and an ischemic sign or symptom. Perioperative risk calculator was used for risk assessment.
  
  
  RESULTS
  Of 385 patients with systematic ischemia screening, 27 patients (7.0%) had perioperative myocardial infarction. The incidence was highest in vascular surgery-19 of 172 patients (11.0%). The 90-day mortality was 29.6% in patients with perioperative myocardial infarction and 5.6% in non-perioperative myocardial infarction patients ( p <  0.001). Perioperative risk calculator predicted perioperative myocardial infarction with an area under curve of 0.73 (95% confidence interval: 0.64-0.81).
  
  
  CONCLUSIONS
  Perioperative myocardial infarction is a common complication associated with a 90-day mortality of 30%. The ability of the perioperative risk calculator to predict perioperative myocardial infarction was fair supporting its routine use.
authors.affiliation: 1 Department of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.|2 Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Ollila
authors.affiliation: 2 Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Vikatmaa
authors.affiliation: 3 Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Virolainen
authors.affiliation: 4 Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Vikatmaa
authors.affiliation: 5 Department of Gastrointestinal Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Leppäniemi
authors.affiliation: 4 Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Albäck
authors.affiliation: 2 Department of Anaesthesiology and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Salmenperä
authors.affiliation: 1 Department of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: V
authors.initials: V
authors.lastname: Pettilä
mesh_terms: D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000209:etiology; D059035:Perioperative Period; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D020107:Troponin T / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods
chemical_list: D020107:Troponin T
keywords: Prospective; myocardial infarction; non-cardiac; observational; perioperative; risk; surgery; troponin T