Which of the following is MOST likely true regarding perioperative myocardial infarction (PMI)?
Perioperative myocardial infarction (PMI) can be due to one of two different mechanisms. The first is the acute disruption of an unstable coronary plaque, which initiates platelet aggregation and occlusive thrombus formation. The second is a sustained imbalance of myocardial oxygen supply and demand in the presence of significant coronary artery disease. Most patients with PMI due to the second mechanism have non-ST-segment elevation myocardial infarction (NSTEMI) (Figure). In general, NSTEMI is the most common type of PMI.
The presence of PMI is associated with increased short- and long-term mortality rates. The Perioperative Ischemic Evaluation trial reported a 30-day mortality of 11.6% for patients who experienced PMI. Approximately 80% of PMIs occur 48 to 72 hours postoperatively. The risk of PMI is increased for up to two weeks after orthopedic surgical procedures.
PMI can be...
