Perioperative MI - Perioperative myocardial infarction...

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Perioperative myocardial infarction after noncardiac surgery INCIDENCE 5.8% overall risk of postoperative cardiac death or major cardiac complications in patients undergoing major noncardiac surgical procedures [Goldman et al. NEJM 1977]. ~3% risk of perioperative MI in patients undergoing nonoperative surgery [Deveraux et al., CMAJ 2005] Risk of 1.4%, 3.2%, to 6.9% in successive surgical patients [Mangano et al., NEJM 1995]. 1.8% incidence of perioperative MI in men over the age of 40, but ranging from 0% to 0.8% to 4.1% [Ashton et al., Ann Intern Med 1993]. High risk patients experienced perioperative MI 3.0% of the time [Mangano et al. NEJM 1990] 4.7-5.6% incidence in patients with known coronary disease [Shah et al. Anesth Analg 1990; Badner et al. Anesthesiology 1998].
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DIAGNOSIS 14% patients have chest pain 53% have a sign or symptom that triggers consideration for perioperative MI Cardiac biomarkers
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Revised Goldman Cardiac Risk Index (RCRI) Independent predictors of major cardiac complications: High-risk operation (intraperitoneal, intrathoracic, suprainguinal vascular procedures) Hx of ischemic heart disease Hx of heart failure Hx of cerebrovascular disease DM requiring insulin Preoperative serum creatinine > 2.0 mg/dL
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Deveraux et al., CMAJ 2005:
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