Postoperative Myocardial Infarction

  • Glynne D. Stanley
  • Sundara K. Rengasamy


Postoperative myocardial infarction (PMI) was first described in 1952. Approximately, 7–8 million noncardiac surgical patients are at the risk of cardiac morbidity or mortality annually. The reported incidence of PMI in the literature varies between 0.0 and 0.7%, and is as high as 37% in patients who have surgery within 3 months of a myocardial infarction (MI). Approximately, 50,000 patients annually have a PMI, of which 20,000 are fatal. There is now a better understanding of the factors that lead to the development of PMI, but many areas of controversy remain. The relationship between perioperative ischemia and PMI is uncertain. The factors leading to PMI in a cardiac surgical population may be different from the noncardiac group, and within the noncardiac group there appears to be varying degrees of risk depending on many factors, including the type of surgical procedure. One undisputed fact is the existence of certain patient populations with increased risk of PMI. The following discussion focuses predominantly on PMI in the noncardiac surgical population.


Single Photon Emission Compute Tomography Pulmonary Capillary Wedge Pressure Dobutamine Stress Echocardiography Major Vascular Surgery Postoperative Myocardial Infarction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wroblewski F, LaDue JS. Myocardial infarction as a postoperative complication of major surgery. JAMA. 1952;150:1212–1216.CrossRefGoogle Scholar
  2. 2.
    Mangano DT. Perioperative cardiac morbidity. Anesthesiology. 1990;72:153–184.PubMedCrossRefGoogle Scholar
  3. 3.
    Tarhan S, Moffitt EA, Taylor WF, Giuliani ER. Myocardial infarction after general anesthesia. JAMA. 1972;220:1451–1454.PubMedCrossRefGoogle Scholar
  4. 4.
    Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845–850.PubMedCrossRefGoogle Scholar
  5. 5.
    Ashton CM, Petersen NJ, Wray NP, et al. The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery. Ann Intern Med. 1993;118:504–510.PubMedCrossRefGoogle Scholar
  6. 6.
    Eagle KA, Coley CM, Newell JB, et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med. 1989;110:859–866.PubMedCrossRefGoogle Scholar
  7. 7.
    Detsky AS, Abrams HB, McLaughlin JR, et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med. 1986;1:211–219.PubMedCrossRefGoogle Scholar
  8. 8.
    Steen PA, Tinker JH, Tarhan S. Myocardial reinfarction after anesthesia and surgery. JAMA. 1978;239:2566–2570.PubMedCrossRefGoogle Scholar
  9. 9.
    Rao TL, Jacobs KH, El-Etr AA. Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology. 1983;59:499–505.PubMedCrossRefGoogle Scholar
  10. 10.
    Hertzer NR. Fatal myocardial infarction following peripheral vascular operations. A study of 951 patients followed 6 to 11 years postoperatively. Cleve Clin Q. 1982;49:1–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Hertzer NR. Basic data concerning associated coronary disease in peripheral vascular patients. Ann Vasc Surg. 1987;1:616–620.PubMedCrossRefGoogle Scholar
  12. 12.
    Nelson AH, Fleisher LA, Rosenbaum SH. Relationship between postoperative anemia and cardiac morbidity in high-risk vascular patients in the intensive care unit. Crit Care Med. 1993;21:860–866.PubMedCrossRefGoogle Scholar
  13. 13.
    Chapman I. Morphogenesis of occluding coronary artery thrombosis. Arch Pathol. 1965;80:256–261.PubMedGoogle Scholar
  14. 14.
    Constantinides P. Plaque fissures in human coronary thrombosis. J Atheroscler Res. 1966;6:1–17.CrossRefGoogle Scholar
  15. 15.
    Kawai C. Pathogenesis of acute myocardial infarction. Novel regulatory systems of bioactive substances in the vessel wall. Circulation. 1994;90:1033–1043.PubMedCrossRefGoogle Scholar
  16. 16.
    Slogoff S, Keats AS. Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology. 1985;62:107–114.PubMedCrossRefGoogle Scholar
  17. 17.
    Badner NH, Knill RL, Brown JE, Novick TV, Gelb AW. Myocardial infarction after noncardiac surgery. Anesthesiology. 1998;88:572–578.PubMedCrossRefGoogle Scholar
  18. 18.
    Latham P, Joshi GP. Coronary revascularization without cardiopulmonary bypass: use of ischemic preconditioning and adenosine. Anesthesiology. 1998;88:828–830.PubMedCrossRefGoogle Scholar
  19. 19.
    Stanley GD, Pierce ET, Moore WJ, Lewis KP, Bode RH Jr. Spinal anesthesia reduces oxygen consumption in diabetic patients prior to peripheral vascular surgery. Reg Anesth. 1997;22:53–58.PubMedCrossRefGoogle Scholar
  20. 20.
    Westenskow DR, Jordan WS. Changes in oxygen consumption induced by fentanyl and thiopentone during balanced anaesthesia. Can Anaesth Soc J. 1978;25:18–21.PubMedCrossRefGoogle Scholar
  21. 21.
    Waxman K, Lazrove S, Shoemaker WC. Physiologic responses to operation in high risk surgical patients. Surg Gynecol Obstet. 1981;152:633–638.PubMedGoogle Scholar
  22. 22.
    Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990;73:308–327.PubMedCrossRefGoogle Scholar
  23. 23.
    Halter JB, Pflug AE, Porte D Jr. Mechanisms of plasma catecholamine increase during surgical stress in man. J Clin Endocrinol Metab. 1977;45:936–944.PubMedCrossRefGoogle Scholar
  24. 24.
    Collins GJ Jr, Barber JA, Zajtchuk R, Vanek D, Malogne LA. The effects of operative stress on the coagulation profile. Am J Surg. 1977;133:612–616.PubMedCrossRefGoogle Scholar
  25. 25.
    Seyfer AE, Seaber AV, Dombrose FA, Urbaniak JRU. Coagulation changes in elective surgery and trauma. Ann Surg. 1981;193:210–213.PubMedCrossRefGoogle Scholar
  26. 26.
    McDaniel MD, Pearce WH, Yao JS, et al. Sequential changes in coagulation and platelet function following femorotibial bypass. J Vasc Surg. 1984;1:261–268.PubMedGoogle Scholar
  27. 27.
    Reeder MK, Muir AD, Foex P, Goldman MD, Loh L, Smart D. Postoperative myocardial ischaemia: temporal association with nocturnal hypoxaemia. Br J Anaesth. 1991;67:626–631.PubMedCrossRefGoogle Scholar
  28. 28.
    Reeder MK, Goldman MD, Loh L, et al. Postoperative hypoxaemia after major abdominal vascular surgery. Br J Anaesth. 1992;68:23–26.PubMedCrossRefGoogle Scholar
  29. 29.
    Gutstein DE, Fuster V. Pathophysiology and clinical significance of atherosclerotic plaque rupture. Cardiovasc Res. 1999;41:323–333.PubMedCrossRefGoogle Scholar
  30. 30.
    Ambrose JA, Weinrauch M. Thrombosis in ischemic heart disease. Arch Intern Med. 1996;156:1382–1394.PubMedCrossRefGoogle Scholar
  31. 31.
    Tofler GH. Triggering and the pathophysiology of acute coronary syndromes. Am Heart J. 1997;134(5 Pt 2):S55–S61.PubMedCrossRefGoogle Scholar
  32. 32.
    Farb A, Burke AP, Tang AL, et al. Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation. 1996;93:1354–1363.PubMedCrossRefGoogle Scholar
  33. 33.
    Plutzky J. Atherosclerotic plaque rupture: emerging insights and opportunities. Am J Cardiol. 1999;84(1A):15J–20J.PubMedCrossRefGoogle Scholar
  34. 34.
    Chapman I. The initiating cause of coronary artery thrombosis: an anatomic study. J Mt Sinai Hosp NY. 1969;36:361–374.Google Scholar
  35. 35.
    Barger AC. Beeuwkes R 3d. Rupture of coronary vasa vasorum as a trigger of acute myocardial infarction. Am J Cardiol. 1990;66:41G–43G.PubMedCrossRefGoogle Scholar
  36. 36.
    Barger AC, Beeuwkes R, Lainey LL, Silverman KJ. Hypothesis: vasa vasorum and neovascularization of human coronary arteries. A possible role in the pathophysiology of atherosclerosis. N Engl J Med. 1984;310(3):175–177.PubMedCrossRefGoogle Scholar
  37. 37.
    Arbustini E, Morbini P, Bello BD, Prati F, Specchia G. From plaque biology to clinical setting. Am Heart J. 1999;138(2 Pt 2):S55–S60.PubMedCrossRefGoogle Scholar
  38. 38.
    Gurfinkel E, Bozovich G, Daroca A, Beck E, Mautner B. Randomised trial of roxithromycin in non-Q-wave coronary syndromes: ROXIS Pilot Study. ROXIS Study Group. Lancet. 1997;350:404–407.PubMedCrossRefGoogle Scholar
  39. 39.
    Raby KE, Barry J, Creager MA, Cook EF, Weisberg MC, Goldman L. Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. JAMA. 1992;268:222–227.PubMedCrossRefGoogle Scholar
  40. 40.
    Le Manach Y, Perel A, Coriat P, Godet G, Bertrand M, Riou B. Early and delayed myocardial infarction after abdominal aortic surgery. Anesthesiology. 2005;102(5):885–891.PubMedCrossRefGoogle Scholar
  41. 41.
    Hertzer NR, Beven EG, Young JR, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984;199:223–233.PubMedCrossRefGoogle Scholar
  42. 42.
    Poldermans D, Arnese M, Fioretti PM, et al. Improved cardiac risk stratification in major vascular surgery with dobutamine-atropine stress echocardiography. J Am Coll Cardiol. 1995;26:648–653.PubMedCrossRefGoogle Scholar
  43. 43.
    Detsky AS, Abrams HB, Forbath N, Scott JG, Hilliard JR. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med. 1986;146:2131–2134.PubMedCrossRefGoogle Scholar
  44. 44.
    Landesberg G, Einav S, Christopherson R, et al. Perioperative ischemia and cardiac complications in major vascular surgery: importance of the preoperative twelve-lead electrocardiogram. J Vasc Surg. 1997;26:570–578.PubMedCrossRefGoogle Scholar
  45. 45.
    Carliner NH, Fisher ML, Plotnick GD, et al. The preoperative electrocardiogram as an indicator of risk in major noncardiac surgery. Can J Cardiol. 1986;2:134–137.PubMedGoogle Scholar
  46. 46.
    Gage AA, Bhayana JN, Balu V, Hook N. Assessment of cardiac risk in surgical patients. Arch Surg. 1977;112:1488–1492.PubMedCrossRefGoogle Scholar
  47. 47.
    Cutler BS, Wheeler HB, Paraskos JA, Cardullo PA. Applicability and interpretation of electrocardiographic stress testing in patients with peripheral vascular disease. Am J Surg. 1981;141:501–506.PubMedCrossRefGoogle Scholar
  48. 48.
    Carliner NH, Fisher ML, Plotnick GD, et al. Routine preoperative exercise testing in patients undergoing major non-cardiac surgery. Am J Cardiol. 1985;56:51–58.PubMedCrossRefGoogle Scholar
  49. 49.
    Gianrossi R, Detrano R, Mulvihill D, et al. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989;80:87–98.PubMedCrossRefGoogle Scholar
  50. 50.
    Raby KE, Goldman L, Creager MA, et al. Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med. 1989;321:1296–1300.PubMedCrossRefGoogle Scholar
  51. 51.
    Boucher CA, Brewster DC, Darling RC, Okada RD, Strauss HW, Pohost GM. Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engl J Med. 1985;312:389–394.PubMedCrossRefGoogle Scholar
  52. 52.
    Leppo J, Plaja J, Gionet M, Tumolo J, Paraskos JA, Cutler BS. Noninvasive evaluation of cardiac risk before elective vascular surgery. J Am Coll Cardiol. 1987;9:269–276.PubMedCrossRefGoogle Scholar
  53. 53.
    Lette J, Waters D, Lapointe J, et al. Usefulness of the severity and extent of reversible perfusion defects during thallium-dipyridamole imaging for cardiac risk assessment before noncardiac surgery. Am J Cardiol. 1989;64:276–281.PubMedCrossRefGoogle Scholar
  54. 54.
    Levinson JR, Boucher CA, Coley CM, Guiney TE, Strauss HW, Eagle KA. Usefulness of semiquantitative analysis of dipyridamole-thallium-201 redistribution for improving risk stratification before vascular surgery. Am J Cardiol. 1990;66:406–410.PubMedCrossRefGoogle Scholar
  55. 55.
    McEnroe CS, O’Donnell RF Jr, Yeager A, Konstam M, Mackey WC. Comparison of ejection fraction and Goldman risk factor analysis of dipyridamole-thallium 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery. J Vasc Surg. 1990;11:497–504.PubMedGoogle Scholar
  56. 56.
    Stratmann HG, Younis LT, Wittry MD, Amato M, Mark AL, Miller DD. Dipyridamole technetium 99m sestamibi myocardial tomography for preoperative cardiac risk stratification before major or minor nonvascular surgery. Am Heart J. 1996;132:536–541.PubMedCrossRefGoogle Scholar
  57. 57.
    Shaw L, Miller DD, Kong BA, et al. Determination of perioperative cardiac risk by adenosine thallium-201 myocardial imaging. Am Heart J. 1992;124:861–869.PubMedCrossRefGoogle Scholar
  58. 58.
    Martin TW, Seaworth JF, Johns JP, Pupa LE, Condos WR. Comparison of adenosine, dipyridamole, and dobutamine in stress echocardiography. Ann Intern Med. 1992;116:190–196.PubMedCrossRefGoogle Scholar
  59. 59.
    Mangano DT, London MJ, Tubau JF, et al. Dipyridamole thallium-201 scintigraphy as a preoperative screening test. A reexamination of its predictive potential. Study of Perioperative Ischemia Research Group. Circulation. 1991;84:493–502.PubMedCrossRefGoogle Scholar
  60. 60.
    Vanzetto G, Machecourt J, Blendea D, et al. Additive value of thallium single-photon emission computed tomography myocardial imaging for prediction of perioperative events in clinically selected high cardiac risk patients having abdominal aortic surgery. Am J Cardiol. 1996;77:143–148.PubMedCrossRefGoogle Scholar
  61. 61.
    Garber AM, Solomon NA. Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease. Ann Intern Med. 1999;130:719–728.PubMedCrossRefGoogle Scholar
  62. 62.
    Halm EA, Browner WS, Tubau JF, Tateo IM, Mangano DT. Echocardiography for assessing cardiac risk in patients having noncardiac surgery. Study of Perioperative Ischemia Research Group. Ann Intern Med. 1996;125:433–441.PubMedCrossRefGoogle Scholar
  63. 63.
    Poldermans D, Fioretti PM, Forster T, et al. Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation. 1993;87:1506–1512.PubMedCrossRefGoogle Scholar
  64. 64.
    Fletcher JP, Antico VF, Gruenewald S, Kershaw LZ. Risk of aortic aneurysm surgery as assessed by preoperative gated heart pool scan. Br J Surg. 1989;76:26–28.PubMedCrossRefGoogle Scholar
  65. 65.
    Mosley JG, Clarke JM, Ell PJ, Marston A. Assessment of myocardial function before aortic surgery by radionuclide angiocardiography. Br J Surg. 1985;72:886–887.PubMedCrossRefGoogle Scholar
  66. 66.
    Pasternack PF, Imparato AM, Riles TS, et al. The value of the radionuclide angiogram in the prediction of perioperative myocardial infarction in patients undergoing lower extremity revascularization procedures. Circulation. 1985;72(3 Pt 2):II13–II17.PubMedGoogle Scholar
  67. 67.
    Mantha S, Roizen MF, Barnard J, Thisted RA, Ellis JE, Foss J. Relative effectiveness of four preoperative tests for predicting adverse cardiac outcomes after vascular surgery: a meta-analysis. Anesth Analg. 1994;79:422–433.PubMedCrossRefGoogle Scholar
  68. 68.
    Eagle KA, Brundage BH, Chaitman BR, et al. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery. Circulation. 1996;93:1278–1317.PubMedGoogle Scholar
  69. 69.
    ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 2007;116(17):e418–e499.Google Scholar
  70. 70.
    Practice guidelines for pulmonary artery catheterization. A report by the American Society of Anesthesiologists Task Force on Pulmonary Artery Catheterization. Anesthesiology 1993;78:380–394.Google Scholar
  71. 71.
    Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–1049.PubMedCrossRefGoogle Scholar
  72. 72.
    Muir AD, Reeder MK, Foex P, Ormerod OJ, Sear JW, Johnston C. Preoperative silent myocardial ischaemia: incidence and predictors in a general surgical population. Br J Anaesth. 1991;67:373–377.PubMedCrossRefGoogle Scholar
  73. 73.
    Charlson ME, MacKenzie CR, Ales KL, Gold JP, Fairclough GF Jr, Shires GT. The post-operative electrocardiogram and creatine kinase: implications for diagnosis of myocardial infarction after non-cardiac surgery. J Clin Epidemiol. 1989;42:25–34.PubMedCrossRefGoogle Scholar
  74. 74.
    Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med. 1990;323:1781–1788.PubMedCrossRefGoogle Scholar
  75. 75.
    Alpert JS, Chipkin SR, Aronin N. Diabetes mellitus and silent myocardial ischemia. Adv Cardiol. 1990;37:297–303.PubMedGoogle Scholar
  76. 76.
    Savage RM, Wagner GS, Ideker RE, Podolsky SA, Hackel DB. Correlation of postmortem anatomic findings with electrocardiographic changes in patients with myocardial infarction: retrospective study of patients with typical anterior and posterior infarcts. Circulation. 1977;55:279–285.PubMedCrossRefGoogle Scholar
  77. 77.
    Andersen PT, Moller-Petersen J, Klaerke A, Henneberg EW. Evaluation of the usefulness of enzymatic diagnosis of myocardial infarction in patients with acute arterial occlusion of the lower extremities. Acta Anaesthesiol Scand. 1987;31:38–43.PubMedCrossRefGoogle Scholar
  78. 78.
    Graeber GM, Clagett GP, Wolf RE, Cafferty PJ, Harmon JW, Rich NM. Alterations in serum creatine kinase and lactate dehydrogenase. Association with abdominal aortic surgery, myocardial infarction and bowel necrosis. Chest. 1990;97:521–527.PubMedCrossRefGoogle Scholar
  79. 79.
    Zimmerman J, Fromm R, Meyer D, et al. Diagnostic marker cooperative study for the diagnosis of myocardial infarction. Circulation. 1999;99:1671–1677.PubMedCrossRefGoogle Scholar
  80. 80.
    Ryan TJ, Antman EM, Brooks NH, et al. 1999 Update. ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1999;34:890–911.PubMedCrossRefGoogle Scholar
  81. 81.
    Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988;2:349–360.Google Scholar
  82. 82.
    Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992;327:669–677.PubMedCrossRefGoogle Scholar
  83. 83.
    Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation. 1990;81:1161–1172.PubMedCrossRefGoogle Scholar
  84. 84.
    Ohman EM, George BS, White CJ, et al. Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction. Results of a randomized trial. The Randomized IABP Study Group. Circulation. 1994;90:792–799.PubMedCrossRefGoogle Scholar
  85. 85.
    Berlauk JF, Abrams JH, Gilmour IJ, O’Connor SR, Knighton DR, Cerra FB. Preoperative optimization of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. A prospective, randomized clinical trial. Ann Surg. 1991;214:289–297.PubMedCrossRefGoogle Scholar
  86. 86.
    Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med. 1996;335:1713–1720.PubMedCrossRefGoogle Scholar
  87. 87.
    Wallace A, Layug B, Tateo I, et al. Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology. 1998;88:7–17.PubMedCrossRefGoogle Scholar
  88. 88.
    Poldermans D, Boersma E, Bax JJ, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med. 1999;341:1789–1794.PubMedCrossRefGoogle Scholar
  89. 89.
    Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med. 2005;353(4):349–361.PubMedCrossRefGoogle Scholar
  90. 90.
    Raby KE, Brull SJ, Timimi F, et al. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg. 1999;88:477–482.PubMedGoogle Scholar
  91. 91.
    Blackburn H. Standardization of the exercise electrocardiogram: a systematic comparison of chest lead configurations employed for monitoring during exercise. In: Karvonen MJ, Barry AJ, editors. Physical activity and the heart. Springfield, IL: CC Thomas; 1967. p. 90.Google Scholar
  92. 92.
    Practice guidelines for perioperative transesophageal echocardiography. A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology 1996;84:986–1006.Google Scholar
  93. 93.
    Dodds TM, Stone JG, Coromilas J, Weinberger M, Levy DG. Prophylactic nitroglycerin infusion during noncardiac surgery does not reduce perioperative ischemia. Anesth Analg. 1993;76(4):705–713.PubMedCrossRefGoogle Scholar
  94. 94.
    Thomson IR, Mutch WA, Culligan JD. Failure of intravenous nitroglycerin to prevent intraoperative myocardial ischemia during fentanyl-pancuronium anesthesia. Anesthesiology. 1984;61:385–393.PubMedCrossRefGoogle Scholar
  95. 95.
    Gallagher JD, Moore RA, Jose AB, Botros SB, Clark DL. Prophylactic nitroglycerin infusions during coronary artery bypass surgery. Anesthesiology. 1986;64:785–789.PubMedCrossRefGoogle Scholar
  96. 96.
    Wallace AW, Galindez D, Salahieh A, et al. Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery. Anesthesiology. 2004;101(2):284–293.PubMedCrossRefGoogle Scholar
  97. 97.
    Poldermans D, Bax JJ, Kertai MD, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation. 2003;107(14):1848–1851.PubMedCrossRefGoogle Scholar
  98. 98.
    Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg. 2004;39(5):967–975.PubMedCrossRefGoogle Scholar
  99. 99.
    Kersten JR, Gross GJ, Pagel PS, Warltier DC. Activation of adenosine triphosphate-regulated potassium channels: mediation of cellular and organ protection. Anesthesiology. 1998;88:495–513.PubMedCrossRefGoogle Scholar
  100. 100.
    Ross S, Foex P. Protective effects of anaesthetics in reversible and irreversible ischaemia-reperfusion injury. Br J Anaesth. 1999;82:622–632.PubMedCrossRefGoogle Scholar
  101. 101.
    Bode RH Jr, Lewis KP, Zarich SW, et al. Cardiac outcome after peripheral vascular surgery. Comparison of general and regional anesthesia. Anesthesiology. 1996;84:3–13.PubMedCrossRefGoogle Scholar
  102. 102.
    Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology. 1987;66:729–736.PubMedCrossRefGoogle Scholar
  103. 103.
    Landesberg G, Shatz V, Akopnik I, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol. 2003;42(9):1547–1554.PubMedCrossRefGoogle Scholar
  104. 104.
    McFalls EO, Ward HB, Moritz TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351(27):2795–2804.PubMedCrossRefGoogle Scholar
  105. 105.
    Sharma AK, Ajani AE, Hamwi SM, et al. Major noncardiac surgery following coronary stenting: when is it safe to operate? Catheter Cardiovasc Interv. 2004;63(2):141–145.PubMedCrossRefGoogle Scholar
  106. 106.
    Chassot PG, Delabays A, Spahn DR. Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth. 2007;99(3):316–328.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Glynne D. Stanley
    • 1
  • Sundara K. Rengasamy
    • 2
  1. 1.Department of AnesthesiaNorth Shore Medical CenterSalemUSA
  2. 2.Department of AnesthesiologyBoston UniversityBostonUSA

Personalised recommendations