Detection and management of perioperative myocardial ischemia.

PURPOSE OF REVIEW: To review the current evidence for detection and management of perioperative myocardial ischemia. RECENT FINDINGS: Patients who sustain a myocardial injury after noncardiac surgery are predominantly asymptomatic. Myocardial injury after noncardiac surgery is associated with both short-term and long-term mortality. Mortality from both cardiac and noncardiac causes is significant. SUMMARY: Perioperative physicians should refrain from the use of nonsurgical diagnostic criteria for myocardial infarction and adopt the clinical entity known as myocardial injury after noncardiac surgery in order to allow for better determination of the prevalence of this perioperative complication. Studies should focus on establishing the feasibility of broad postoperative troponin surveillance following noncardiac surgery. Clinical trials of potential therapies for myocardial injury after noncardiac surgery are urgently needed.