The Expanding Universe of Perioperative Myocardial Infarction.

I n this issue of the Journal, Parashar et al. (1) present a single-center 10-year retrospective analysis characterizing patients undergoing coronary angiography after perioperative myocardial infarction (MI). The authors present an analysis of angiograms from 1,093 patients with perioperative MI anddescribe the high risk nature of associated percutaneous coronary intervention (PCI). The death rate for ST-elevation myocardial infarction (STEMI) PCI patients after noncardiac surgery is alarming: the 30-day mortality rate (31.2%) is so high that these results should enhance discussions of adequate risk adjustment in national registries. Based on these important findings from the Cleveland Clinic, we can unfortunately join 3 groups together in terms of PCI risk: those with cardiogenic shock, cardiac arrest, and perioperative MI after noncardiac surgery.