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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2011 Gennaio;77(1):64-73
When is the risk acceptable to proceed to noncardiac surgery following an acute myocardial infarction?
Semark A. 1, Rodseth R. N. 1,2, Biccard B. M. 1,2 ✉
1 Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa;
2 Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Mayville, 4091, South Africa
There is a large degree of uncertainty regarding the optimal time delay between an acute (≤7 days) or recent (8-30 days) myocardial infarction and a patient undergoing scheduled, noncardiac surgery. Historically, the re-infarction rate for patients undergoing non-cardiac surgery within three months of a myocardial infarction has been 5%, with a very high associated mortality rate. The American Heart Association has suggested that non-cardiac surgery is acceptable six weeks after a myocardial infarction. This review considers the pathophysiology of resolution, the therapeutic responses to acute myocardial infarctions and the predictors of outcome, which may assist with the risk-benefit analysis concerning an appropriate time to proceed with non-cardiac surgery following an acute myocardial infarction. These predictors include the presence of cardiac failure, as evaluated clinically by cardiac echocardiography and increases in B-type natriuretic proteins, and the presence of persistent ischemia, as evaluated by elevations in troponin levels and ST-segment depression.