Triggers of perioperative myocardial ischaemia and infarction.

Cardiac complications are a major cause of morbidity and mortality after non-cardiac surgery. 64 However, the exact nature of perioperative myocardial injury remains elusive and an area of continued debate and controversy. 64 If triggers of perioperative myocardial ischaemic events could be identi®ed, appropriately taken preventive measures might improve perioperative cardiac outcome. Identi®cation of possible triggers of perioperative myocardial ischaemia and infarction requires knowledge of their incidence, diagnosis and characteristics; of the pathophysiology of acute coronary syndromes (ACS) in the nonsurgical setting; and of factors and interventions that have been shown to affect perioperative myocardial injury. The following review will address these areas before attempting to de®ne the possible mechanisms and triggers of perioperative myocardial ischaemia and infarction.