Diagnosing perioperative myocardial infarction in cardiothoracic and vascular surgery

Patients undergoing cardiac and high-risk noncardiac surgery have a high incidence of perioperative myocardial infarction. The early diagnosis of perioperative myocardial injury in these patients is complicated. In the perioperative period, there is a high incidence of nonspecific electrocardiographic changes and cardiac biomarker release. It is becoming increasingly important to differentiate myocardial necrosis from nonspecific changes because of the need for early intervention and the potential long term implications of a perioperative myocardial event. Although sensitive and specific assays to assess myocardial damage have been developed, specific thresholds to establish the occurrence a significant perioperative event have not been firmly defined. This review will attempt to outline the current evidence supporting the use of clinical symptoms, electrocardiographic changes, and cardiac biomarkers in the diagnosis of perioperative myocardial infarction and the longterm implication of these findings.