Myocardial infarction in patients undergoing noncardiac surgery1

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Coronary artery disease is the leading cause of death in the United States and other industrialized nations. Patients with coronary artery disease are at high risk for myocardial infarction following noncardiac surgery. The authors identify 28 such patients with a 43% mortality rate. Ninety-three percent of infarctions occurred within the first two postoperative days. Chest pain was the presenting symptom in only 39% of these patients. Other presenting signs and symptoms included hypotension, heart failure, alteration of mental status, various atrial and ventricular arrhythmias, and cardiac tamponade from ventricular rupture. Advanced age and identified coronary atherosclerosis seemed to be dominant risk factors.



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