PERIOPERACINIS MIOKARDO INFARKTAS

Abstract

Perioperative myocardial infarction (PMI) is defined as myocardial infarction (MI) during perioperative period (24-72 hours after non cardiac surgery). Worldwide, over 200 million adults have major non-cardiac surgery each year, and several million experience a major vascular complication (e.g.: nonfatal myocardial infarction). The prevalence of PMI for low risk patients without ischemic heart disease is from 0.3 to 3%, while for medium and high risk patients with coronary artery disease increases to 30%. It is believed that plaque rupture and myocardial oxygen supply-demand imbalance is the main reason of perioperative myocardial infarction. Mostly oxygen supply-demand imbalance predominates in the early postoperative period. Plaque rupture appears to be a more random event, distributed over the entire perioperative admission. Most patients with a perioperative MI do not experience ischemic symptoms, because of sedation and analgesia during surgery procedure. This is the reason why routine monitoring of troponin levels and electrocardiography in at-risk patients are needed after surgery to detect most MI. In 90% of cases troponin level inceases during the first 24 hours after surgery. Risk factors detection, serial troponin evaluation and specialised treatment can reduce hospital length of stay, treatment costs and PMI mortality.