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J Am Coll Cardiol, 2008; 51:1825-1826, doi:10.1016/j.jacc.2008.01.035
© 2008 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Perioperative Myocardial Infarction Has Been Forgotten

Danielle Menosi Gualandro, MD*, Bruno Caramelli, MD, PhD, Pai Ching Yu, MD, Andre Coelho Marques, MD and Daniela Calderaro, MD

* Heart Institute, University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44 Cerqueira Cesar, São Paulo—SP, CEP 05403000, Brazil (Email: danielle.gualandro{at}incor.usp.br).

Thygesen et al. (1) have published a consensus report that reviews the definition of myocardial infarction (MI) and proposes a new classification of 5 categories based on differences in pathophysiology. We believe that this definition is flawed in 1 respect: it does not mention perioperative MI. This is not the first time that a MI definition has been questioned. When the consensus document of the Joint European Society of Cardiology/American College of Cardiology redefinition of MI was released, Tunstall-Pedoe (2) indicated several problems with that document. Some of those problems have been solved in this new classification (e.g., the inclusion of fatal cases of MI). This new classification includes spontaneous MI (type 1), MI secondary to ischemia due to either increased oxygen demand or reduced supply (type 2), sudden cardiac deaths or cardiac arrest (type 3), MI associated with percutaneous coronary intervention (type 4), and MI associated with coronary artery bypass grafting (type 5). This classification could be useful to develop future studies analyzing different treatments according to the group to which the patient belongs. However, it is our opinion that an important group of patients has been forgotten: those with MI related to noncardiac surgeries. The etiology and pathophysiology of myocardial ischemia and infarction in this setting are still controversial subjects and could fit either in types 1 or 2. Based on pathology studies (3,4), we believe that perioperative MI have similar pathophysiology to spontaneous MI; therefore, they should be treated the same way. As a complement of Thygesen's classification, we suggest the inclusion of MI after noncardiac surgeries in type 1 MI of the new classification because this inclusion may have implications for the management of acute coronary syndromes in this setting.


   References
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 References
 

  1. Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction J Am Coll Cardiol 2007;50:2173-2195.[Free Full Text]
  2. Tunstall-Pedoe H. Redefinition of myocardial infarction by a consensus dissenter J Am Coll Cardiol 2001;37:1472-1473.[Free Full Text]
  3. Cohen MC, Aretz TH. Histological analysis of coronary artery lesions in fatal postoperative myocardial infarction Cardiovasc Pathol 1999;8:133-139.[CrossRef][ISI][Medline]
  4. Dawood MM, Gupta DK, Southern J, Walia A, Atkinson JB, Eagle KA. Pathology of fatal perioperative myocardial infarction: implications regarding pathophysiology and prevention Int J Cardiol 1996;57:37-44.[CrossRef][ISI][Medline]

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Kristian Thygesen, Joseph S. Alpert, Allan S. Jaffe, Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction
J. Am. Coll. Cardiol. 2008 51: 1826-1827. [Full Text] [PDF]




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