The Potential Preventability of Postoperative Myocardial Infarction

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Abstract
Each year, as many as 1 million Americans who undergo major noncardiac surgery suffer a perioperative cardiac complication.1,2 Among these complications, the development of postoperative myocardial infarction (MI) is of particular concern, because it is associated with a markedly increased risk for death, prolonged hospitals stays, and higher costs.3-6 Epidemiological studies carried out during the past 3 decades have identified numerous factors associated with cardiovascular complications after surgery and led to the development of a series of clinical prediction tools.5,7-10 Despite these advances, few strategies have been shown to reduce the occurrence of complications and, until recently, most prevention efforts have focused on the selective use of coronary revascularization in patients identified as being at the highest risk. Several randomized trials have demonstrated that the perioperative administration of β-adrenergic blockers to selected patients can reduce the incidence of postoperative myocardial ischemia, MI, and mortality.11-15 On the basis of these studies, recent reviews2,16-18 have suggested that β-blockers be used routinely in all but the lowest-risk individuals, and β-blockade is recommended in perioperative management guidelines produced by both the American College of Physicians and the American College of Cardiology.19,20 The Agency for Healthcare Research and Quality report, Making Health Care Safer: A Critical Analysis of Patient Safety Practices,21 placed perioperative β-blockade near the top of its short list of interventions labeled "clear opportunities for safety improvement."