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Diagnostic criteria for the redefinition of acute myocardial infarction (AMI) have been recently published.1 In this new classification, intraoperative (IPEMI) or post-operative (POMI) AMI, in the setting of non-cardiac surgery, were not included.

It is well known that this category of AMI occurs under particular circumstances while the diagnostic criteria have not been fully elucidated.2

Patients with pre-operative cardiac risk undergoing intermediate or high surgical risk operations are more prone to IPEMI and POMI. Meanwhile, stent thrombosis in patients with coronary artery disease undergoing non-cardiac surgery could pose a specific risk factor, because the time for complete endothelization varies among subjects. This risk increases in case of pre-operative anticoagulation therapy alteration for fear of bleeding.3

Mortality from IPEMI and POMI varies between 40 and 70%, especially because these are frequently underdiagnosed. On top, patients during the perioperative period cannot easily complain of angina. During surgery, it is not necessary to have haemodynamic instability, for an AMI to occur. Subtle ST-segment changes in electrocardiogram are not always appreciated, unless there is a computerized monitor analysis. The majority of perioperative AMIs are non-Q wave and electrocardiographic changes are therefore non-specific.

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Letters to the Editor
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