P.J. Devereaux, MD, PhD; Denis Xavier, MD, MSc; Janice Pogue, MSc; Gordon Guyatt, MD, MSc; Alben Sigamani, MD; Ignacio Garutti, MD, PhD; Kate Leslie, MD, MEpi; Purnima Rao-Melacini, MSc; Sue Chrolavicius, RN; Homer Yang, MD; Colin MacDonald, MD; Alvaro Avezum, MD, PhD; Luc Lanthier, MD, MSc; Weijiang Hu, MD; Salim Yusuf, MBBS, DPhil; on behalf of the POISE (PeriOperative ISchemic Evaluation) Investigators
Each year, millions of patients worldwide have a perioperative myocardial infarction (MI) after noncardiac surgery.
To examine the characteristics and short-term outcome of perioperative MI.
Cohort study. (ClinicalTrials.gov registration number: NCT00182039)
190 centers in 23 countries.
8351 patients included in the POISE (PeriOperative ISchemic Evaluation) trial.
Four cardiac biomarker or enzyme assays were measured within 3 days of surgery. The definition of perioperative MI included either autopsy findings of acute MI or an elevated level of a cardiac biomarker or enzyme and at least 1 of the following defining features: ischemic symptoms, development of pathologic Q waves, ischemic changes on electrocardiography, coronary artery intervention, or cardiac imaging evidence of MI.
Within 30 days of random assignment, 415 patients (5.0%) had a perioperative MI. Most MIs (74.1%) occurred within 48 hours of surgery; 65.3% of patients did not experience ischemic symptoms. The 30-day mortality rate was 11.6% (48 of 415 patients) among patients who had a perioperative MI and 2.2% (178 of 7936 patients) among those who did not (P < 0.001). Among patients with a perioperative MI, mortality rates were elevated and similar between those with (9.7%; adjusted odds ratio, 4.76 [95% CI, 2.68 to 8.43]) and without (12.5%; adjusted odds ratio, 4.00 [CI, 2.65 to 6.06]) ischemic symptoms.
Cardiac markers were measured only until day 3 after surgery, and additional asymptomatic MIs may have been missed.
Most patients with a perioperative MI will not experience ischemic symptoms. Data suggest that routine monitoring of troponin levels in at-risk patients is needed after surgery to detect most MIs, which have an equally poor prognosis regardless of whether they are symptomatic or asymptomatic.
Canadian Institutes of Health Research.
Devereaux P, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I, et al. Characteristics and Short-Term Prognosis of Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery: A Cohort Study. Ann Intern Med. ;154:523–528. doi: 10.7326/0003-4819-154-8-201104190-00003
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Published: Ann Intern Med. 2011;154(8):523-528.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Coronary Risk Factors.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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