Document Detail

Therapy insight: prophylaxis, monitoring and treatment of perioperative myocardial ischemia with emphasis on urological surgery.
MedLine Citation:
PMID:  17551537     Owner:  NLM     Status:  MEDLINE    
Unrecognized or silent perioperative myocardial ischemia is common in patients who undergo high-risk surgery, including cystectomy, and could predict cardiac morbidity and mortality in postoperative patients. This disorder is not merely a marker of extensive coronary disease but has a close association with perioperative myocardial infarction (PMI). In a review of published data, including meta-analyses, in the context of high-risk urological surgery, up to 50% of PMIs were found to go unrecognized if only clinical signs and symptoms are considered. Prevention and treatment of these previously unrecognized cardiac events might significantly reduce long-term morbidity and mortality. The emergence of reliable markers of PMI, such as increased levels of troponin I, could help in the detection of events that would have otherwise remained unnoticed. In this Review we examine the effect of these developments in the context of high-risk urological surgery. Changes to preoperative assessment, perioperative management, and prophylaxis of PMI are critically assessed. We performed a prospective audit using postoperative troponin I levels to assess the rate of silent perioperative myocardial ischemia and infarction. An increasingly proactive attitude towards perioperative monitoring for myocardial ischemia and infarction has evolved, and postoperative serial screening with troponin I might be beneficial in high-risk patients undergoing major urological surgery.
Mathias H Winkler; Eric K Mayer; David Hrouda; Patrick Doyle
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Nature clinical practice. Urology     Volume:  4     ISSN:  1743-4289     ISO Abbreviation:  -     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-06-06     Completed Date:  2007-07-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101226508     Medline TA:  Nat Clin Pract Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  333-40     Citation Subset:  IM    
Department of Urology, Charing Cross Hospital, London, UK.
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MeSH Terms
Aged, 80 and over
Myocardial Ischemia / drug therapy,  etiology,  prevention & control*
Postoperative Complications / prevention & control*
Risk Factors
Treatment Outcome
Urologic Surgical Procedures, Male / adverse effects*

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