Perioperative infarction and myocardial injury: risk factors, mechanisms of development and clinical and epidemiological features
- Authors: Shulenin K.S.1, Cherkashin D.V.1, Solovyev I.A.1, Kuchev R.D.1, Popova A.V.1
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Affiliations:
- Military Medical Academy of S.M. Kirov
- Issue: Vol 24, No 3 (2022)
- Pages: 557-566
- Section: Review
- URL: https://journals.rcsi.science/1682-7392/article/view/108976
- DOI: https://doi.org/10.17816/brmma108976
- ID: 108976
Cite item
Abstract
Тhe concept, risk factors, mechanisms, clinical and epidemiological, and angiographic features of perioperative ischemic injury and myocardial infarction were considered. Perioperative myocardial infarction is one of the most common complications (up to 3.6%) in non-cardiac surgical interventions and is characterized by high in-hospital mortality, reaching 25%. Most patients with this pathology (up to 65%) do not have typical symptoms of myocardial ischemia due to anesthesia and sedation. Pathogenetic mechanisms of perioperative myocardial infarction development continues to be actively studied. A critical increase in myocardial oxygen demand is indicated as the leading cause in some studies. Angiography reveals rupture of the coronary plaque and atherothrombosis in more than half of patients, according to other data. These contradictions point to the need for further epidemiological studies using coronary angiography with a focus on risk factors and triggers of this complication. In addition, the concept of perioperative myocardial injury in recent years has been formulated in the scientific literature. This is understood as ischemic damage that occurs in the first 30 days after surgery. Recent studies have shown that it can occur in 16% of surgical patients and is associated with a 6-fold increase in mortality within 1 month after surgery and a 2.5-fold increase within a year. It is important that perioperative myocardial injury does not include cases of non-ischemic etiology myocardial injury, for example, due to pulmonary embolism, sepsis, or electrical cardioversion. Thus, the assessment and understanding of risk factors for the development of perioperative myocardial ischemia is of great practical importance in optimizing the patient selection and preparation for surgical treatment.
Full Text
##article.viewOnOriginalSite##About the authors
Konstantin S. Shulenin
Military Medical Academy of S.M. Kirov
Author for correspondence.
Email: shulenink@mail.ru
ORCID iD: 0000-0002-3141-7111
SPIN-code: 8476-1052
Doctor of Medical Sciences, Associate Professor
Russian Federation, Saint PetersburgDmitry V. Cherkashin
Military Medical Academy of S.M. Kirov
Email: cherkashin_dmitr@mail.ru
ORCID iD: 0000-0003-1363-6860
SPIN-code: 2781-9507
Doctor of Medical Sciences, Professor
Russian Federation, Saint PetersburgIvan A. Solovyev
Military Medical Academy of S.M. Kirov
Email: ivsolov@yandex.ru
ORCID iD: 0000-0001-9646-9775
SPIN-code: 6703-4852
Doctor of Medical Sciences, Professor
Russian Federation, Saint PetersburgRafiq D. Kuchev
Military Medical Academy of S.M. Kirov
Email: dag_vmrg@mail.ru
SPIN-code: 4454-7582
Lecturer
Russian Federation, Saint PetersburgAnna V. Popova
Military Medical Academy of S.M. Kirov
Email: anyapopova1994@mail.ru
ORCID iD: 0000-0003-4357-2861
Cardiologist
Russian Federation, Saint PetersburgReferences
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