Document Detail


Perioperative myocardial infarction--aetiology and prevention.
MedLine Citation:
PMID:  15665072     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Perioperative myocardial infarction (PMI) is one of the most important predictors of short- and long-term morbidity and mortality associated with non-cardiac surgery. Prevention of a PMI is thus a prerequisite for an improvement in overall postoperative outcome. The aetiology of PMI is multifactorial. The perioperative period induces large, unpredictable and unphysiological alterations in coronary plaque morphology, function and progression, and may trigger a mismatch of myocardial oxygen supply and demand. With many diverse factors involved, it is unlikely that one single intervention will successfully improve cardiac outcome following non-cardiac surgery. A multifactorial, step-wise approach is indicated. Based on increasing knowledge of the nature of atherosclerotic coronary artery disease, and in view of the poor positive predictive value of non-invasive cardiac stress tests, and the considerable risk of coronary angiography and coronary revascularization in high-risk patients, the paradigm is shifting from an emphasis on extensive non-invasive preoperative risk stratification to a combination of selective non-invasive testing and aggressive pharmacological perioperative therapy. Perioperative plaque stabilization by pharmacological means may be as important in the prevention of PMI as an increase in myocardial oxygen supply or a reduction in myocardial oxygen demand.
Authors:
H-J Priebe
Publication Detail:
Type:  Journal Article; Review     Date:  2005-01-21
Journal Detail:
Title:  British journal of anaesthesia     Volume:  95     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-08     Completed Date:  2005-07-19     Revised Date:  2005-12-21    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  3-19     Citation Subset:  IM    
Affiliation:
University Hospital/Department of Anaesthesia, Freiburg, Germany. priebe@ana1.uk.uni-freiburg.de
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adrenergic beta-Antagonists / therapeutic use
Coronary Angiography / methods
Humans
Intraoperative Complications / etiology*,  mortality,  prevention & control
Myocardial Infarction / etiology*,  mortality,  prevention & control
Myocardial Revascularization / methods
Preoperative Care / methods
Stents
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists
Comments/Corrections
Comment In:
Br J Anaesth. 2005 Dec;95(6):835; author reply 835-6   [PMID:  16286351 ]
Br J Anaesth. 2005 Jul;95(1):1-2   [PMID:  15941733 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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