Perioperative myocardial injury and infarction following non-cardiac surgery: A review of the eclipsed epidemic.
Cardiac troponins
ischemic imbalance
major adverse cardiovascular event
myocardial injury after non-cardiac surgery
oxygen supply-demand mismatch
perioperative myocardial infarction
Journal
Saudi journal of anaesthesia
ISSN: 1658-354X
Titre abrégé: Saudi J Anaesth
Pays: India
ID NLM: 101500601
Informations de publication
Date de publication:
Historique:
received:
05
08
2019
accepted:
02
09
2019
entrez:
31
1
2020
pubmed:
31
1
2020
medline:
31
1
2020
Statut:
ppublish
Résumé
The perioperative period induces unpredictable and significant alterations in coronary plaque characteristics which may culminate as adverse cardiovascular events in background of a compromised myocardial oxygen supply and demand balance. This "ischemic-imbalance" provides a substrate for perioperative cardiac adversities which incur a considerable morbidity and mortality. The propensity of myocardial injury is dictated by the conglomeration of various factors like pre-existing medical condition, high-risk surgical interventions, intraoperative hemodynamic management, and the postoperative care. Perioperative myocardial infarction (PMI) differs from myocardial infarction (MI) in a non-operative setting. PMI can often be notoriously "silent" demonstrating a conspicuous absence of the classic clinical symptoms. Moreover, myocardial injury following non-cardiac surgery (MINS) characterized by an elevation of the cardiac insult biomarkers has demonstrated an independent prognostic significance in the perioperative scenario despite the lack of a formal categorization as PMI. This has evoked interest in the meticulous characterization of MINS as a discrete clinical entity. Multifactorial etiology, varying symptomatology, close differential diagnosis, and a debatable management regime makes perioperative myocardial injury-infarction, a subject of detailed discussion.
Identifiants
pubmed: 31998026
doi: 10.4103/sja.SJA_499_19
pii: SJA-14-91
pmc: PMC6970380
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
91-99Informations de copyright
Copyright: © 2020 Saudi Journal of Anesthesia.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
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