Anest. intenziv. Med. 2018;29(1):14-22

Perioperative myocardial injury: Our fault or inflammation?Anaesthesiology - Review articles

K. Skarvan

Departement Anästhesie und Intensivmedizin, Universitätssspital Basel, Švýcarsko

In approximately one in ten patients undergoing major non-cardiac surgery, abnormal increases in plasma levels of high sensitivity cardiac troponin occur during the first postoperative days, suggesting postoperative myocardial injury. Most of these patients have no signs or symptoms of myocardial ischaemia or infarction. Nonetheless, they are at increased risk of both 30-day and long-term all-cause mortality as well as higher incidence of major cardiovascular adverse events, comparable to type 2 postoperative myocardial infarction. The myocardial injury is deemed to result from critical imbalance of myocardial O2 demand and supply. The pathophysiology, clinical implications and prevention of this condition are reviewed, and an alternative interpretation of the mechanisms causing cardiomyocyte necrosis - inflammation - is presented.

Keywords: high sensitivity cardiac troponin; non-cardiac surgery; myocardial injury; ischaemia; mortality; adverse events; inflammation; statins

Received: August 29, 2017; Accepted: January 12, 2018; Published: February 1, 2018  Show citation