PT - JOURNAL ARTICLE AU - P.J. Devereaux AU - Lee Goldman AU - Salim Yusuf AU - Ken Gilbert AU - Kate Leslie AU - Gordon H. Guyatt TI - Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review AID - 10.1503/cmaj.050316 DP - 2005 Sep 27 TA - Canadian Medical Association Journal PG - 779--788 VI - 173 IP - 7 4099 - http://www.cmaj.ca/content/173/7/779.short 4100 - http://www.cmaj.ca/content/173/7/779.full SO - CMAJ2005 Sep 27; 173 AB - THIS IS THE SECOND OF 2 ARTICLES EVALUATING cardiac events in patients undergoing noncardiac surgery. Unrecognized myocardial infarctions (MIs) are common, and up to 50% of perioperative MIs may go unrecognized if physicians rely only on clinical signs or symptoms. In this article, we summarize the evidence regarding monitoring strategies for perioperative MI in patients undergoing noncardiac surgery. Perioperative troponin measurements and 12-lead electrocardiograms can detect clinically silent MIs and provide independent prognostic information. Currently, there are no standard diagnostic criteria for perioperative MIs in patients undergoing noncardiac surgery. We propose diagnostic criteria that reflect the unique features of perioperative MIs. Finally, we review the evidence for perioperative prophylactic cardiac interventions. There is encouraging evidence that some perioperative interventions (e.g., β-blockers, α2-adrenergic agonists, statins) may prevent major cardiac ischemic events, but firm conclusions await the results of large definitive trials. The best evidence does not support a management strategy of preoperative coronary revascularization before noncardiac surgery.