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Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

  • Internal Medicine
  • Review Article Cardiovascular Diseases
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Abstract

Advances in surgical and anaesthetic techniques and an aging patient population have resulted in more complex procedures being performed in greater numbers of aged subjects and in patients with a high likelihood of significant cardiovascular disease. Nearly one fourth of non-cardiac surgical procedures (major intra-abdominal, thoracic, vascular, and orthopaedic procedures) performed in persons older than 65 years have been found to be associated with significant perioperative cardiovascular morbidity and mortality.

During previous years the main attempt was to define strategies to accurately estimate perioperative cardiovascular risk based either on the characteristics of surgery and on patient characteristics. More recently preventive medical strategies have been proposed. Therefore, the physician has to be aware of the key elements useful to calculate the perioperative cardiovascular risk, and of the medical preventive treatment or further interventions to adopt in patients candidate to surgery.

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References

  1. National Confidential Enquiry into Patient Outcome and Death. 2003/04 Death data. Available at http://www.ncepod.org.uk/pdf/200304DeathData.pdf; accessed 10 February 2006.

  2. National Confidential Enquiry into Patient Outcome and Death. General data. Available at http://www.ncepod.org.uk/pdf/2000/tan/TaNGen.pdf; accessed 10 February 2006.

  3. Lunn JN, Devlin HB. Lessons from the confidential enquiry into perioperative deaths in three NHS regions.Lancet 1987; 2: 1384–6.

    Article  PubMed  CAS  Google Scholar 

  4. National Confidential Enquiry into Patient Outcome and Death. Surgery. Available at http://www.ncepod.org.uk/pdf/2000/tan/TaNSurg.pdf; accessed 10 February 2006.

  5. Poldermans D, Boersma E, Bax JJ, et al. 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.

    Article  PubMed  CAS  Google Scholar 

  6. Auerbach AD. Chapter 25: Beta-blockers and reduction of perioperative cardiac events. Available at http://www.ahcpr.gov/CLINIC/PTSAFETY/chap25.htm; accessed 10 February 2006.

  7. Landesberg G, Mosseri M, Zahger D, et al. Myocardial infarction after vascular surgery: the role of prolonged stress-induced, ST depression-type ischemia.J Am Coll Cardiol 2001; 37: 1839–45.

    Article  PubMed  CAS  Google Scholar 

  8. Adams JE 3rd, Sicard GA, Allen BT, et al. Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I.N Engl J Med 1994; 330: 670–4.

    Article  PubMed  Google Scholar 

  9. Katus HA, Looser S, Hallermayer K, et al. Development and in vitro characterization of a new immunoassay of cardiac troponin T.Clin Chem 1992; 38: 386–93.

    PubMed  CAS  Google Scholar 

  10. Adams JE 3rd, Bodor GS, Davila-Roman VG, et al. Cardiac troponin I. A marker with high specificity for cardiac injury.Circulation 1993; 88: 101–6.

    PubMed  Google Scholar 

  11. Lee TH, Thomas EJ, Ludwig LE, et al. Troponin T as a marker for myocardial ischemia in patients undergoing major noncardiac surgery.Am J Cardiol 1996; 77: 1031–6.

    Article  PubMed  CAS  Google Scholar 

  12. Metzler H, Gries M, Rehak P, Lang T, Fruhwald S, Toller W. Perioperative myocardial cell injury: the role of troponins.Br J Anaesth 1997; 78: 386–90.

    PubMed  CAS  Google Scholar 

  13. Sarko J, Pollack CV Jr. Cardiac troponins.J Emerg Med 2002; 23: 57–65.

    Article  PubMed  Google Scholar 

  14. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction.J Am Coll Cardiol 2000; 36: 959–69.

    Article  PubMed  CAS  Google Scholar 

  15. Relos RP, Hasinoff IK, Beilman GJ. Moderately elevated serum troponin concentrations are associated with increased morbidity and mortality rates in surgical intensive care unit patients.Crit Care Med 2003; 31: 2598–603.

    Article  PubMed  CAS  Google Scholar 

  16. Mangano DT, Browner WS, Hollenberg M, et al. 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.

    PubMed  CAS  Google Scholar 

  17. Backer CL, Tinker JH, Robertson DM, Vlietstra RE. Myocardial reinfarction following local anesthesia for ophthalmic surgery.Anesth Analg 1980; 59: 257–62.

    Article  PubMed  CAS  Google Scholar 

  18. Greenburg AG, Saik RP, Pridham D. Influence of age on mortality of colon surgery.Am J Surg 1985; 150: 65–70.

    Article  PubMed  CAS  Google Scholar 

  19. Ashton CM, Petersen NJ, Wray NP, et al. The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery.Ann Intern Med 1993; 118: 504–10.

    PubMed  CAS  Google Scholar 

  20. Detsky AS, Abrams HB, McLaughlin JR, et al. Predicting cardiac complications in patients undergoing non-cardiac surgery.J Gen Intern Med 1986; 1: 211–9.

    Article  PubMed  CAS  Google Scholar 

  21. Foster ED, David KB, Carpenter JA, et al. Risk of noncardiac operation in patients with defined coronary disease: the Coronary Artery Surgery Study (CASS) registry experience.Ann Thorac Surg 1986; 41: 42–50.

    PubMed  CAS  Google Scholar 

  22. Mangano DT. Perioperative cardiac morbidity.Anesthesiology 1990; 72: 153–84.

    Article  PubMed  CAS  Google Scholar 

  23. Raby KE, Goldman L, Creager MA, et al. Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery.N Engl J Med 1989; 321: 1296–300.

    PubMed  CAS  Google Scholar 

  24. Shah KB, Kleinman BS, Rao TLK, Jacobs HK, Mestan K, Schaafsma M. Angina and other risk factors in patients with cardiac diseases undergoing noncardiac operations.Anesth Analg 1990; 70: 240–7.

    PubMed  CAS  Google Scholar 

  25. Baron JF, Mundler O, Bertrand M, et al. Dipyridamolethallium scintigraphy and gated radionuclide angiography to assess cardiac risk before abdominal aortic surgery.N Engl J Med 1994; 330: 663–9.

    Article  PubMed  CAS  Google Scholar 

  26. Eagle KA, Coley CM, Newell JB, et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery.Ann Intern Med 1989; 110: 859–66.

    PubMed  CAS  Google Scholar 

  27. Hendel RC, Whitfield SS, Villegas BJ, Cutler BS, Leppo JA. Prediction of late cardiac events by dipyridamole thallium imaging in patients undergoing elective vascular surgery.Am J Cardiol 1992; 70: 1243–9.

    Article  PubMed  CAS  Google Scholar 

  28. Lette J, Waters D, Cerino M, Picard M, Champagne P, Lapoint J. Preoperative coronary artery disease risk stratification based on dipyridamole imaging and a simple three-step, three-segment model for patients undergoing noncardiac vascular surgery or major general surgery.Am J Cardiol 1992; 69: 1553–8.

    Article  PubMed  CAS  Google Scholar 

  29. Brown KA, Rowen M. Extent of jeopardized viable myocardium determined by myocardial perfusion imaging best predicts perioperative cardiac events in patients undergoing noncardiac surgery.J Am Coll Cardiol 1993; 21: 325–30.

    PubMed  CAS  Google Scholar 

  30. McFalls EO, Doliszny KM, Grund F, Chute E, Chesler E. Angina and persistent exercise thallium defects: independent risk factors in elective vascular surgery.J Am Coll Cardiol 1993; 21: 1347–52.

    PubMed  CAS  Google Scholar 

  31. Bry JD, Belkin M, O’Donnell TF Jr, et al. An assessment of the positive predictive value and cost-effectiveness of dipyridamole myocardial scintigraphy in patients undergoing vascular surgery.J Vasc Surg 1994; 19: 112–24.

    PubMed  CAS  Google Scholar 

  32. Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary. A report of American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on perioperative Cardiovascular Evaluation for Noncardiac Surgery).Circulation 2002; 105: 1257–67.

    PubMed  Google Scholar 

  33. Fleischmann KE, Goldman L, Young B, Lee TH. Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay.Am J Med 2003; 115: 515–20.

    Article  PubMed  Google Scholar 

  34. Fischer SP. Development and effectiveness of an anesthesia preoperative evaluation clinic in a teaching hospital.Anesthesiology 1996; 85: 196–206.

    Article  PubMed  CAS  Google Scholar 

  35. Liu LL, Wiener-Kronish JP. Preoperative cardiac evaluation of women for noncardiac surgery.Cardiol Clin 1998; 16: 59–66.

    Article  PubMed  CAS  Google Scholar 

  36. Tarhan S, Moffitt EA, Taylor WF, Giuliani ER. Myocardial infarction after general anesthesia.JAMA 1972; 220: 1451–4.

    Article  PubMed  CAS  Google Scholar 

  37. Rao TL, Jacobs KH, El-Etr AA. Reinfarction following anesthesia in patients with myocardial infarction.Anesthesiology 1983; 59: 499–505.

    Article  PubMed  CAS  Google Scholar 

  38. Becker RC, Underwood DA. Myocardial infarction in patients undergoing noncardiac surgery.Cleve Clin J Med 1987; 54: 25–8.

    PubMed  CAS  Google Scholar 

  39. Dawood MM, Gutpa DK, Southern J, Walia A, Atkinson JB, Eagle KA. Pathology of fatal perioperative myocardial infarction: implications regarding pathophysiology and prevention.Int J Cardiol 1996; 57: 37–44.

    Article  PubMed  CAS  Google Scholar 

  40. Rosing DR, Brakman P, Redwood DR, et al. Blood fibrinolytic activity in man. Diurnal variation and the response to varying intensities of exercise.Circ Res 1970; 27: 171–84.

    PubMed  CAS  Google Scholar 

  41. Green LH, Seroppian E, Handin RI. Platelet activation during exercise-induced myocardial ischemia.N Engl J Med 1980; 302: 193–7.

    PubMed  CAS  Google Scholar 

  42. Cohen MC, Aretz TH. Histological analysis of coronary artery lesions in fatal postoperative myocardial infarction.Cardiovasc Pathol 1999; 8: 133–9.

    Article  PubMed  CAS  Google Scholar 

  43. Breslow MJ, Parker SD, Frank SM, et al. Determinants of catecholamine and cortisol responses to lower extremity revascularization. The PIRAT Study Group.Anesthesiology 1993; 79: 1202–9.

    Article  PubMed  CAS  Google Scholar 

  44. Indolfi C, Ross J Jr. The role of heart rate in myocardial ischemia and infarction: implications of myocardial perfusion-contraction matching.Prog Cardiovasc Dis 1993; 36: 61–74.

    Article  PubMed  CAS  Google Scholar 

  45. Landesburg G, Zhou W, Aversano T. Tachycardia-induced subendocardial necrosis in acutely instrumented dogs with fixed coronary stenosis.Anesth Analg 1999; 88: 973–9.

    Article  PubMed  CAS  Google Scholar 

  46. Nabel EG, Selwyn AP, Ganz P. Large coronary arteries in humans are responsive to changing blood flow: an endothelium-dependent mechanism that fails in patients with atherosclerosis.J Am Coll Cardiol 1990; 16: 349–56.

    Article  PubMed  CAS  Google Scholar 

  47. Sambuceti G, Marzilli A, Maraccini P, et al. Coronary vasoconstriction during myocardial ischemia induced by rises in metabolic demand in patients with coronary artery disease.Circulation 1997; 95: 2652–9.

    PubMed  CAS  Google Scholar 

  48. Morrow DA, Cannon CP, Rifai N, et al, for the TACTICS-TIMI 18 Investigators. Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial.JAMA 2001; 286: 2405–12.

    Article  PubMed  CAS  Google Scholar 

  49. Raby KE, Barry J, Creager MA, Cook EF, Weisberg MC, Gooldman L. Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery.JAMA 1992; 268: 222–7.

    Article  PubMed  CAS  Google Scholar 

  50. Killewich LA, Macko RF, Gardner AW, Cox K, Lilly MP, Flinn WR. Defective fibrinolysis occurs after infrainguinal reconstruction.J Vasc Surg 1997; 25: 858–64.

    Article  PubMed  CAS  Google Scholar 

  51. Rosenfeld BA, Beattie C, Christopherson R, et al. for the Perioperative Ischemia Randomized Anesthesia Trial Study Group. The effects of different anesthetic regimens on fibrinolysis and the development of postoperative arterial thrombosis.Anesthesiology 1993; 79: 435–43.

    Article  PubMed  CAS  Google Scholar 

  52. Gibbs NM, Crawford GP, Michalopoulos N. Postoperative changes in coagulant and anticoagulant factors following abdominal aortic surgery.J Cardiothorac Vasc Anesth 1992; 6: 680–5.

    Article  PubMed  CAS  Google Scholar 

  53. Gibbs NM, Crawford GP, Michalopoulos N. A comparison of postoperative thrombotic potential following abdominal aortic surgery, carotid endarterectomy, and femoropopliteal bypass.Anaesth Intensive Care 1996; 24: 11–4.

    PubMed  CAS  Google Scholar 

  54. Wiman B. Plasminogen activator inhibitor 1 in thrombotic disease.Curr Opin Hematol 1996; 3: 372–8.

    Article  PubMed  CAS  Google Scholar 

  55. Sarbinowski R, Arvidsson S, Tylman M, Oresland T, Bengtsson A. Plasma concentration of procalcitonin and systemic inflammatory response syndrome after colorectal surgery.Acta Anaesthesiol Scand 2005; 49: 191–6.

    Article  PubMed  CAS  Google Scholar 

  56. Mokart D, Merlin M, Sannini A, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery.Br J Anaesth 2005; 94: 767–73.

    Article  PubMed  CAS  Google Scholar 

  57. Swartbol P, Truedsson L, Norgren L. The inflammatory response and its consequence for the clinical outcome following aortic aneurysm repair.Eur J Vasc Endovasc Surg 2001; 21: 393–400.

    Article  PubMed  CAS  Google Scholar 

  58. Baigrie RJ, Lamont PM, Kwiatkowski D, Dallman MJ, Morris PJ. Systemic cytokine response after major surgery.Br J Surg 1992; 79: 757–60.

    Article  PubMed  CAS  Google Scholar 

  59. Roumen RM, Hendriks T, van der Ven-Jongekrijg J, et al. Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure.Ann Surg 1993; 218: 769–76.

    Article  PubMed  CAS  Google Scholar 

  60. Swartbol P, Parsson H, Truedsson L, Sjoholm A, Norgren L. Aortobifemoral surgery induces complement activation and release of interleukin-6 but not tumour necrosis factor-alpha.Cardiovasc Surg 1996; 4: 483–91.

    Article  PubMed  CAS  Google Scholar 

  61. Groeneveld AB, Raijmakers PG, Rauwerda JA, Hack CE. The inflammatory response to vascular surgery-associated ischaemia and reperfusion in man: effect on postoperative pulmonary function.Eur J Vasc Endovasc Surg 1997; 14: 351–9.

    Article  PubMed  CAS  Google Scholar 

  62. Armstrong EJ, Morrow DA, Sabatine MS. Inflammatory biomarkers in acute coronary syndromes. Part I: Introduction and cytokines.Circulation 2006; 113: e72–75.

    Article  PubMed  Google Scholar 

  63. Giardina JB, Green GM, Cockrell KL, Granger JP, Khalil RA. TNF-alpha enhances contraction and inhibits endothelial NO-cGMP relaxation in systemic vessels of pregnant rats.Am J Physiol Regul Integr Comp Physiol 2002; 283: R130-R143.

    PubMed  CAS  Google Scholar 

  64. Pittet D, Rangel-Frausto S, Li N, et al. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients.Intensive Care Med 1995; 21: 302–9.

    Article  PubMed  CAS  Google Scholar 

  65. Haga Y, Beppu T, Doi K, et al. Systemic inflammatory response syndrome and organ dysfunction following gastrointestinal surgery.Crit Care Med 1997; 25: 1994–2000.

    Article  PubMed  CAS  Google Scholar 

  66. Talmor M, Hydo L, Barie PS. Relationship of systemic inflammatory response syndrome to organ dysfunction, length of stay, and mortality in critical surgical illness: effect of intensive care unit resuscitation.Arch Surg 1999; 134: 81–7.

    Article  PubMed  CAS  Google Scholar 

  67. Kertai MD, Boersma E, Klein J, et al. Optimizing the prediction of perioperative mortality in vascular surgery by using a customized probability model.Arch Intern Med 2005; 165: 898–904.

    Article  PubMed  Google Scholar 

  68. Harrell FE Jr, Califf RM, Pryor DB, Lee KL, Rosati RA. Evaluating the yield of medical tests.JAMA 1982; 247: 2543–6.

    Article  PubMed  Google Scholar 

  69. Hertzer NR, Beven EG, Young JR, et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management.Ann Surg 1984; 199: 223–33.

    Article  PubMed  CAS  Google Scholar 

  70. Meldrum DR. Tumor necrosis factor in the heart.Am J Physiol 1998; 274 (Pt 2): R577-R595.

    PubMed  CAS  Google Scholar 

  71. L’Italien GJ, Cambria RP, Cutler BS, et al. Comparative early and late cardiac morbidity among patients requiring different vascular surgery procedures.J Vasc Surg 1995; 21: 935–44.

    Article  PubMed  CAS  Google Scholar 

  72. Boersma E, Poldermans D, Bax JJ, et al. Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and betablocker therapy.JAMA 2001; 285: 1865–73.

    Article  PubMed  CAS  Google Scholar 

  73. Lederle FA, Wilson SE, Johnson GR, et al. for the Aneurysm Detection and Management Veterans Affairs Cooperative Group. Immediate repair compared with surveillance of small abdominal aortic aneurysms.N Engl J Med 2002; 346: 1437–44.

    Article  PubMed  Google Scholar 

  74. Schinkel AF, Elhendy A, van Domburg RT, Bax JJ, Roelandt JR, Poldermans D. Prognostic value of dobutamine-atropine stress (99m)Tc-tetrofosmin myocardial perfusion SPECT in patients with known or suspected coronary artery disease.J Nucl Med 2002; 43: 767–72.

    PubMed  Google Scholar 

  75. Bond R, Rerkasem K, Shearman CP, Rothwell PM. Time trends in the published risks of stroke and death due to endarterectomy for symptomatic carotid stenosis.Cerebrovasc Dis 2004; 18: 37–46.

    Article  PubMed  CAS  Google Scholar 

  76. Eagle KA, Lim MJ, Dabbous OH, et al, for the GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry.JAMA 2004; 291: 2727–33.

    Article  PubMed  CAS  Google Scholar 

  77. Gregg EW, Cadwell BL, Cheng YJ, et al. Trends in the prevalence and ratio of diagnosed to undiagnosed diabetes according to obesity levels in the US.Diabetes Care 2004; 27: 2806–12.

    Article  PubMed  Google Scholar 

  78. Smetana GW. Medical evaluation of the surgical patient. In: Kasper DL, Braunwald E, Fauci AS, et al, eds. Harrison’s principles of internal medicine. 16th ed. New York, NY: McGraw-Hill, 2005: 60–71.

    Google Scholar 

  79. Chaitman BR, Miller DD. Perioperative cardiac evaluation for noncardiac surgery noninvasive cardiac testing.Prog Cardiovasc Dis 1998; 40: 405–18.

    Article  PubMed  CAS  Google Scholar 

  80. 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 Group.N Engl J Med 1996; 335: 1713–20.

    Article  PubMed  CAS  Google Scholar 

  81. Devereux PJ, Beattie WS, Choi PT, et al. How strong is the evidence for the use of perioperative beta blockers in noncardiac surgery? Systematic review and meta-analysis of randomised controlled trials.BMJ 2005; 331: 313–21.

    Article  CAS  Google Scholar 

  82. McGory ML, Maggard ML, Ko CY. A meta-analysis of perioperative beta blockade: what is the actual risk reduction?Surgery 2005; 138: 171–9.

    Article  PubMed  Google Scholar 

  83. Poldermans D, Bax JJ, Kertai MD, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery.Circulation 2003; 107: 1848–51.

    Article  PubMed  CAS  Google Scholar 

  84. Lindenauer PK, Pekow P, Wang K, Gutierrez B, Benjamin EM. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery.JAMA 2004; 291: 2092–9.

    Article  PubMed  CAS  Google Scholar 

  85. Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial.J Vasc Surg 2004; 39: 967–75.

    Article  PubMed  Google Scholar 

  86. Landesberg G, Mosseri M, Shatz V, et al. Cardiac troponin after major vascular surgery: the role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization.J Am Coll Cardiol 2004; 44: 569–75.

    Article  PubMed  CAS  Google Scholar 

  87. Guest TM, Ramanathan AV, Tuteur PG, Schechtman KB, Ladenson JH, Jaffe AS. Myocardial injury in critically ill patients. A frequently unrecognized complication.JAMA 1995; 273: 1945–9.

    Article  PubMed  CAS  Google Scholar 

  88. Turner A, Tsamitros M, Bellomo R. Myocardial cell injury in septic shock.Crit Care Med 1999; 27: 1775–80.

    Article  PubMed  CAS  Google Scholar 

  89. Jeremias A, Gibson CM. Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded.Ann Intern Med 2005; 142: 786–91.

    PubMed  Google Scholar 

  90. Higgins JP, Higgins JA. Elevation of cardiac troponin I indicates more than myocardial ischemia.Clin Invest Med 2003; 26: 133–47.

    PubMed  CAS  Google Scholar 

  91. Hamm CW, Ravkilde J, Gerhardt W, et al. The prognostic value of serum troponin T in unstable angina.N Engl J Med 1992; 327: 146–50.

    PubMed  CAS  Google Scholar 

  92. Suleiman MS, Lucchetti V, Caputo M, Angelini GD. Short periods of regional ischaemia and reperfusion provoke release of troponin I from the human hearts.Clin Chim Acta 1999; 284: 25–30.

    Article  PubMed  CAS  Google Scholar 

  93. Wu AH, Ford L. Release of cardiac troponin in acute coronary syndromes: ischemia or necrosis?Clin Chim Acta 1999; 284: 161–74.

    Article  PubMed  CAS  Google Scholar 

  94. Wu AH. Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression?Intensive Care Med 2001; 27: 959–61.

    Article  PubMed  CAS  Google Scholar 

  95. Ammann P, Fehr T, Minder EI, Gunter C, Bertel O. Elevation of troponin I in sepsis and septic shock.Intensive Care Med 2001; 27: 965–9.

    Article  PubMed  CAS  Google Scholar 

  96. ver Elst KM, Spapen HD, Nguyen DN, Garbar C, Huyghens LP, Gorus KK. Cardiac troponins I and T are biological markers of left ventricular dysfunction in septic shock.Clin Chem 2000; 46: 650–7.

    Google Scholar 

  97. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—2002: summary article. A report of American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina).Circulation 2002; 106: 1893–900.

    Article  PubMed  Google Scholar 

  98. Buhaescu I, Izzedine H, Covic A. Cardiac troponins in renal failure—time for an optimistic consensus?Int J Clin Pract 2005; 59: 1317–25.

    Article  PubMed  CAS  Google Scholar 

  99. Kontos MC, Garg R, Anderson FP, Tatum JL, Ornato JP, Jesse RL. Outcomes in patients admitted for chest pain with renal failure and troponin I elevations.Am Heart J 2005; 150: 674–80.

    Article  PubMed  CAS  Google Scholar 

  100. Kim LJ, Tinez EA, Faraday N, et al. Cardiac troponin I predicts short-term mortality in vascular surgery patients.Circulation 2002; 106: 2366–71.

    Article  PubMed  CAS  Google Scholar 

  101. Filipovic M, Jeger R, Probst C, et al. Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease.J Am Coll Cardiol 2003; 42: 1767–76.

    Article  PubMed  CAS  Google Scholar 

  102. Landesberg G, Shatz V, Akopnik I, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery.J Am Coll Cardiol 2003; 42: 1547–54.

    Article  PubMed  CAS  Google Scholar 

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  1. Clinica Medica e Cardiologia, Dipartimento di Area Critica Medico Chirurgica, Università degli Studi, Firenze, Viale Morgagni 85, 50134, Firenze, Italy

    Pietro Amedeo Modesti, Ignazio Simonetti & Giuseppe Olivo

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Modesti, P.A., Simonetti, I. & Olivo, G. Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications. Int Emergency Med 1, 177–186 (2006). https://doi.org/10.1007/BF02934735

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