Southern African Journal of Anaesthesia and Analgesia

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The treatment of perioperative myocardial infarctions following noncardiac surgery

L Ryan, BM Biccard


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.
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