The treatment of perioperative myocardial infarctions following noncardiac surgery
Abstract
Background: Perioperative myocardial infarction (PMI) is a common complication following noncardiac surgery, with a 30-day mortality of 10-20%. Effective therapeutic interventions are of public health importance.Method: This is a systematic review, aimed to determine the evidence for therapies following PMI.
Results: A PubMed Central search up to May 2011 identified 20 case series and reports (89 patients). We extracted data on the type and timing of treatment and short-term mortality. Short-term mortality differed significantly between haemodynamically stable and unstable patients (0% and 32.2% respectively, p-value = 0.015). Significantly more haemodynamically unstable patients received acute coronary interventions (75.8% vs. 23.1%, p-value = 0.0006). Acute coronary intervention in
haemodynamically unstable patients was not associated with improved short-term survival (p-value = 0.53). The high proportion of symptomatic and haemodynamically unstable patients suggests publication bias (÷2 = 16.29, p-value = 0 < 0001 and ÷2 = 154.41, p-value < 0.0001, respectively).
Conclusion: This systematic review highlights the paucity of evidence for PMI management, and the need for future prospective trials.
By submitting manuscripts to SAJAA, authors of original articles are assigning copyright to the SA Society of Anaesthesiologists. Authors may use their own work after publication without written permission, provided they acknowledge the original source. Individuals and academic institutions may freely copy and distribute articles published in SAJAA for educational and research purposes without obtaining permission.