Tuesday, April 19, 2011
In the April issue of the Annals of Internal Medicine PJ Devereaux and colleagues provided the largest descriptive cohort of perioperative myocardial infarction (MI) to date; exploring data from the perioperative course of 8531 patients enrolled in the POISE trial (Lancet 2008).
Disturbingly, 35% of all perioperative MI were without symptoms. The majority of all MIs occurred within 48 hours of surgery. 30 day mortality among those with MI (symptomatic or not) was 4 fold that of those without. Notably, the patient population in this study included patients with some elevated degree of cardiac risk. Thus, in our patients undergoing intermediate to high risk surgeries who have underlying coronary risk factors, it may be reasonable to increase postoperative monitoring to include at minimum a follow up EKG compared to preoperative EKG and possibly postoperative cardiac enzymes.