Postoperative Myocardial Infarction

  • Glynne D. Stanley
  • R. Sundarakumaran


Postoperative myocardial infarction (PMI) was first described in 1952 (1). Approximately 7 to 8 million noncardiac surgical patients are at risk for cardiac morbidity or mortality annually (2). The reported incidence of PMI in the literature varies between 0.0 and 0.7% (2) and is as high as 37% in patients who have surgery within 3 months of a myocardial infarction (MI) (3). Approximately 50,000 patients annually have a PMI and 20,000 are fatal (2). 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 non-cardiac group, and within the non-cardiac group there appear to be varying degrees of risk depending on many factors, including the type of surgical procedure (3–10). One undisputed fact is the existence of certain patient populations at increased risk of PMI (11). The following discussion focuses predominantly on PMI in the non-cardiac surgical population.


Cardiac Risk Dobutamine Stress Echocardiography Noncardiac Surgery Major Vascular Surgery Aortic Aneurysm Surgery 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wroblewski F, LaDue JS. Myocardial infarction as a postoperative complication of major surgery. JAMA 1952; 150: 1212–6.CrossRefGoogle Scholar
  2. 2.
    Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72: 153–84.PubMedCrossRefGoogle Scholar
  3. 3.
    Tarhan S, Moffitt EA, Taylor WF, Giuliani ER. Myocardial infarction after general anesthesia. JAMA 1972;: 220: 1451–4.Google Scholar
  4. 4.
    Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, Burke DS, O’Malley TA, Goroll AH, Caplan CH, Nolan J, Carabello B, Slater EE. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: 845–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Ashton CM, Petersen NJ, Wray NP, Kiefe CI, Dunn JK, Wu L, Thomas JM. The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery. Ann Intern Med 1993; 118: 504–10.PubMedGoogle Scholar
  6. 6.
    Eagle KA, Coley CM, Newell JB, Brewster DC, Darling RC, Strauss 11W, Guiney TE, Boucher CA. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989; 110: 859–66.PubMedGoogle Scholar
  7. 7.
    Detsky AS, Abrams HB, McLaughlin JR, Drucker DJ, Sasson Z, Johnston N, Scott JG, Forbath N, Hilliard JR. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med 1986; 1: 211–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Steen PA, Tinker JH, Tarhan S. Myocardial reinfarction after anesthesia and surgery. JAMA 1978; 239: 2566–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Rao TL, Jacobs KH, EI-Etr AA. Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 1983; 59: 499–505.Google 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.PubMedGoogle Scholar
  11. 11.
    Hertzer NR. Basic data concerning associated coronary disease in peripheral vascular patients. Ann Vasc Surg. 1987; 1: 616–20.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: 860–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Chapman I. Morphogenesis of occluding coronary artery thrombosis. Arch Pathol 1965; 80: 256–61.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: 1033–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Slogoff S, Keats AS. Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 1985; 62: 107–14.PubMedCrossRefGoogle Scholar
  17. 17.
    Badner NH, Knill RL, Brown JE, Novick TV, Gelb AW. Myocardial infarction after noncardiac surgery. Anesthesiology 1998; 88: 572–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Latham P, Joshi GP. Coronary revascularization without cardiopulmonary bypass: use of ischemic preconditioning and adenosine. Anesthesiology 1998; 88: 828–30.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: 53–8.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: 633–8.PubMedGoogle Scholar
  22. 22.
    Weissman C. The metabolic response to stress: an overview and update. Anesthesiology 1990; 73: 308–27.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: 936–44.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: 612–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Seyfer AE, Seaber AV, Dombrose FA, Urbaniak JRU. Coagulation changes in elective surgery and trauma. Ann Surg 1981; 193: 210–3.PubMedCrossRefGoogle Scholar
  26. 26.
    McDaniel MD, Pearce WH, Yao JS, Rossi EC, Fahey VA, Green D, Flinn WR, Bergan JJ. Sequential changes in coagulation and platelet function following femorotibial bypass. J Vasc Surg 1984; 1: 261–8.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: 626–31.PubMedCrossRefGoogle Scholar
  28. 28.
    Reeder MK; Goldman MD; Loh L; Muir AD; Foex P; Casey KR; McKenzie PJ. Postoperative hypoxaemia after major abdominal vascular surgery. Br J Anaesth 1992; 68: 23–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Gutstein DE, Fuster V. Pathophysiology and clinical significance of atherosclerotic plaque rupture. Cardiovasc Res 1999; 41: 323–33.PubMedCrossRefGoogle Scholar
  30. 30.
    Ambrose JA, Weinrauch M. Thrombosis in ischemic heart disease. Arch Intern Med 1996; 156: 1382–94.PubMedCrossRefGoogle Scholar
  31. 31.
    Tofler GH. Triggering and the pathophysiology of acute coronary syndromes. Am Heart J 1997; 134 (5 Pt 2): S55–61.PubMedCrossRefGoogle Scholar
  32. 32.
    Farb A, Burke AP, Tang AL, Liang TY, Mannan P, Smialek J, Virmani R. Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation 1996; 93: 1354–63.PubMedCrossRefGoogle Scholar
  33. 33.
    Plutzky J. Atherosclerotic plaque rupture: emerging insights and opportunities. Am J Cardiol 1999; 84 (1 A): 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: 361–74.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 3d, 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): 175–7.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): S55–60.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: 404–7.Google 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: 222–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Hertzer NR, Beven EG, Young JR, O’Hara PJ, Ruschhaupt WF 3d, Graor RA, Dewolfe VG, Maljovec LC. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg 1984; 199: 223–33.PubMedCrossRefGoogle Scholar
  41. 41.
    Poldermans D. Arnese M, Fioretti PM, Salustri A, Boersma E. Thomson IR, Roelandt JR, van Urk H. Improved cardiac risk stratification in major vascular surgery with dobutamine-atropine stress echocardiography. J Am Coll Cardiol 1995; 26: 648–53.PubMedCrossRefGoogle Scholar
  42. 42.
    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: 2131–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Landesberg G, Einav S, Christopherson R, Beattie C, Berlatzky Y, Rosenfeld B, Eidelman LA, Norris E, Anner H, Mosseri M, Cotev S, Luria MH. Perioperative ischemia and cardiac complications in major vascular surgery: importance of the preoperative twelve-lead electrocardiogram. J Vasc Surg 1997; 26: 570–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Carliner NH, Fisher ML, Plotnick GD, Moran GW, Kelemen MH, Gadacz TR, Peters RW. The preoperative electrocardiogram as an indicator of risk in major noncardiac surgery. Can J Cardiol 1986; 2: 134–7.PubMedGoogle Scholar
  45. 45.
    Gage AA, Bhayana JN, Balu V, Hook N. Assessment of cardiac risk in surgical patients. Arch Surg 1977; 112: 1488–92.PubMedCrossRefGoogle Scholar
  46. 46.
    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: 501–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Carliner NH, Fisher ML, Plotnick GD, Garbart H, Rapoport A, Kelemen MH, Moran GW, Gadacz T, Peters RW. Routine preoperative exercise testing in patients undergoing major non-cardiac surgery. Am J Cardiol 1985; 56: 51–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Gianrossi R, Detrano R, Mulvihill D, Lehmann K, Dubach P, Colombo A, McArthur D, Froelicher V. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation. 1989; 80: 87–98.PubMedCrossRefGoogle Scholar
  49. 49.
    Raby KE, Goldman L, Creager MA, Cook EF, Weisberg MC, Whittemore AD, Selwyn AP Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery N Engl J Med 1989; 321: 1296–300.Google Scholar
  50. 50.
    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: 389–94.PubMedCrossRefGoogle Scholar
  51. 51.
    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: 269–76.PubMedCrossRefGoogle Scholar
  52. 52.
    Lette J, Waters D, Lapointe 7, Gagnon A, Picard M, Cerino M, Kerouac M. 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: 276–81.PubMedCrossRefGoogle Scholar
  53. 53.
    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: 406–10.PubMedCrossRefGoogle Scholar
  54. 54.
    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
  55. 55.
    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: 536–41.PubMedCrossRefGoogle Scholar
  56. 56.
    Shaw L, Miller DD, Kong BA, Hilton T, Stelken A, Stocke K, Chaitman BR. Determination of perioperative cardiac risk by adenosine thallium-201 myocardial imaging. Am Heart J 1992; 124: 861–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Martin TW, Seaworth JE, Johns JP, Pupa LE, Condos WR. Comparison of adenosine, dipyridamole, and dobutamine in stress echocardiography. Ann Intern Med 1992; 116: 190–6.PubMedGoogle Scholar
  58. 58.
    Mangano DT, London MJ, Tubau JF, Browner WS, Hollenberg M, Krupski W, Layug EL, Massie B. Dipyridamole thallium-201 scintigraphy as a preoperative screening test. A reexamination of its predictive potential. Study of Perioperative Ischemia Research Group. Circulation 1991; 84: 493502.Google Scholar
  59. 59.
    Vanzetto G, Machecourt J, Blendea D, Fagret D, Borrel E, Magne JL, Gattaz F, Guidicelli H. 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: 143–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Garber AM, Solomon NA. Cost-effectiveness of alternative test strategies for the diagnosis of coronary artery disease. Ann Intern Med 1999; 130: 719–28.PubMedGoogle Scholar
  61. 61.
    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: 433–41.PubMedGoogle Scholar
  62. 62.
    Poldermans D, Fioretti PM, Forster T, Thomson IR, Boersma E, el-Said EM, du Bois NA, Roelandt JR, van Uric H. Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery. Circulation 1993; 87: 1506–12.PubMedCrossRefGoogle Scholar
  63. 63.
    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: 26–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Mosley JG, Clarke JM, Ell PJ, Marston A. Assessment of myocardial function before aortic surgery by radionuclide angiocardiography. Br J Surg 1985; 72: 886–7.PubMedCrossRefGoogle Scholar
  65. 65.
    Pasternack PF, Imparato AM, Riles TS, Baumann FG, Bear G, Lamparello PJ, Benjamin D, Sanger J, Kramer E. 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): 1113–7.Google Scholar
  66. 66.
    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: 422–33.PubMedCrossRefGoogle Scholar
  67. 67.
    Eagle KA, Brundage BH, Chaitman BR, Ewy GA, Fleisher LA, Hertzer NR, Leppo JA, Ryan T, Schlant RC, Spencer WH 3rd, Spittell JA Jr, Twiss RD, Ritchie JL, Cheitlin MD, Gardner TJ, Garson A Jr, Lewis RP, Gibbons RJ, O’Rourke RA, Ryan TJ. 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: 1278–317.PubMedGoogle Scholar
  68. 68.
    Palda VA. Detsky AS. Perioperative assessment and management of risk from coronary artery disease. Ann Intern Med 1997; 127: 313–28.PubMedGoogle Scholar
  69. 69.
    Practice guidelines for pulmonary artery catheterization. A report by the American Society of Anesthesiologists Task Force on Pulmonary Artery Catheterization. Anesthesiology 1993; 78: 380–94.CrossRefGoogle Scholar
  70. 70.
    Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EI, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK, Ludwig LE, Pedan A, Goldman L Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100: 1043–9.PubMedCrossRefGoogle Scholar
  71. 71.
    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: 373–7.PubMedCrossRefGoogle Scholar
  72. 72.
    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 I989; 42: 25–34.Google Scholar
  73. 73.
    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: 1781–8.CrossRefGoogle Scholar
  74. 74.
    Alpert JS, Chipkin SR, Aronin N. Diabetes mellitus and silent myocardial ischemia. Adv Cardiol 1990; 37: 297–303.PubMedGoogle Scholar
  75. 75.
    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: 279–85.PubMedCrossRefGoogle Scholar
  76. 76.
    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
  77. 77.
    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: 521–7.PubMedCrossRefGoogle Scholar
  78. 78.
    Zimmerman J, Fromm R, Meyer D, Boudreaux A, Wun CC, Smalling R, Davis B, Habib G, Roberts R. Diagnostic marker cooperative study for the diagnosis of myocardial infarction. Circulation 1999; 99: 1671–7PubMedCrossRefGoogle Scholar
  79. 79.
    Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E, Riegel B, Russell RO, Smith EE 3rd, Weaver WD, Gibbons RJ, Alpert JS, Eagle KA, Gardner TJ, Garson A Jr, Gregoratos G, Ryan Ti, Smith SC Jr. 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.CrossRefGoogle Scholar
  80. 80.
    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: 349–60.PubMedGoogle Scholar
  81. 81.
    Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ Jr, Cuddy TE, Davis BR, Geltman EM, Goldman S, Fiaker GC, Klein M, Lamas GA, Packer M, Rouleau J, Rouleau JL, Rutherford J, Wertheimer JH, Hawkins CM. 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: 669–77.PubMedCrossRefGoogle Scholar
  82. 82.
    Pfeffer MA, Braunwald E Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation 1990; 81: 1161–72.PubMedCrossRefGoogle Scholar
  83. 83.
    Ohman EM, George BS, White CJ, Kern MJ, Gurbel PA, Freedman RI, Lundergan C, Hartmann JR, Talley JD, Frey MJ, Taylor G, Leimberger JD, Owens PM, Lee KL, Stack RS, Califf RM. 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: 792–9.PubMedCrossRefGoogle Scholar
  84. 84.
    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: 289–97.PubMedCrossRefGoogle Scholar
  85. 85.
    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 Grouop. N Engl J Med 1996; 335: 1713–20.PubMedCrossRefGoogle Scholar
  86. 86.
    Wallace A, Layug B, Tateo I, Li J, Hollenberg M, Browner W, Miller D, Mangano DT. Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology 1998; 88: 7–17.PubMedCrossRefGoogle Scholar
  87. 87.
    Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL, Blankensteijn JD, Baars HF, Yo TI, Trocino G, Vigna C, Roelandt JR, van Uric H. 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: 1789–94.PubMedCrossRefGoogle Scholar
  88. 88.
    Raby KE, Broil SJ, Timimi F, Akhtar S, Rosenbaum S, Naimi C, Whittemore AD. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg 1999; 88: 477–82.PubMedGoogle Scholar
  89. 89.
    Blackburn H. Standardization of the exercise electrocardiogram: a systematic comparison of chest lead configurations employed for monitoring during exercise. In: Karvonen MJ, Barry Ai, eds. Physical activity and the heart. Springfield, IL: CC Thomas, 1967: 90.Google Scholar
  90. 90.
    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.CrossRefGoogle Scholar
  91. 91.
    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): 705–13.PubMedCrossRefGoogle Scholar
  92. 92.
    Thomson IR, Mutch WA, Culligan JD. Failure of intravenous nitroglycerin to prevent intraoperative myocardial ischemia during fentanyl-pancuronium anesthesia. Anesthesiology 1984; 61: 385–93.PubMedCrossRefGoogle Scholar
  93. 93.
    Gallagher JD, Moore RA, Jose AB, Botros SB, Clark DL. Prophylactic nitroglycerin infusions during coronary artery bypass surgery. Anesthesiology 1986; 64: 785–9.PubMedCrossRefGoogle Scholar
  94. 94.
    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
  95. 95.
    Ross S; Foex P. Protective effects of anaesthetics in reversible and irreversible ischaemia- reperfusion injury. Br J Anaesth 1999; 82: 622–32.PubMedCrossRefGoogle Scholar
  96. 96.
    Bode RH Jr, Lewis KP, Zarich SW, Pierce ET, Roberts M, Kowalchuk GJ, Satwicz PR, Gibbons GW, Hunter JA, Espanola CC. Cardiac outcome after peripheral vascular surgery. Comparison of general and regional anesthesia. Anesthesiology 1996; 84: 3–13.PubMedCrossRefGoogle Scholar
  97. 97.
    Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology 1987; 66: 729–36.PubMedCrossRefGoogle Scholar
  98. 98.
    Thompson JF, Mullee MA, Bell PR, Campbell WB, Chant AD, Darke SG, Jamieson CW, Murk J, Parvin SD, Perry M, Ruckley CV, Wolfe IN, Clyne CA. Intraoperative heparinisation, blood loss and myocardial infarction during aortic aneurysm surgery: a Joint Vascular Research Group study. Eur J Vasc Endovasc Surg 1996; 12: 86–90.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Glynne D. Stanley
    • 1
  • R. Sundarakumaran
    • 1
  1. 1.Boston University School of MedicineBostonUSA

Personalised recommendations