Perioperative myocardial injury: individual and population implications

In summary, it is clear that perioperative myocardial infarction is a significant issue in patients undergoing vascular surgery. While the incidence of perioperative cardiac complications may be lower in patients undergoing other types of non-cardiac surgery, there are many more of these patients and their impact on the population burden of disease may be greater. Identifying patients at the highest risk of perioperative infarction can be difficult, and risk scores, while potentially of value for population studies, are not an ideal tool for directing care in the individual patient. To some extent this is due to the relatively low incidence of perioperative cardiac events and, thus, the problem in identifying a person likely to suffer such an event. However, studies with cardiac troponins make it clear that the incidence may not be as low as first thought and imply that subclinical perioperative myocardial injury may, in fact, be quite common. Further studies are needed in this field, but if this is the case the development of formal strategies for preventing, identifying and managing subclinical preoperative myocardial injury may be appropriate. © The Board of Management and Trustees of the British Journal of Anaesthesia 2004.