| Abstract | The incidence of coronary artery disease and its diagnosis is increasing panicularly in well developed countries. It is estimated that 40 million adults in North America have some degree of coronary artery disease. The annual number of patients suffering acute myocardial infarction exceeds 1.5 million and death attributed to CAD exceeds 550,000. Among 25 million operations performed in the United States every year, there are 400,000 cardiac surgeries and it is estimated that 1 milion non cardiac surgery patients have confirmed CAD and 2 or 3 million patients are at a higher risk of CAD. The main risk of anesthesia and surgery in patients with CAD is perioperative myocardial, ischemia which is estimated to be about 10% in patients above 65 years old and 5% in paticnts above 45 years old. The incidence of perioperative MI is definitely related to the age of myocardial infarction. Mortality rate complicating perioperative MI is much higher than mortality rate complicating reinfarction in coronary care units. Perioperative MI is frequently silent and usually occurs during the first three postop days. 「Risk Factors」The risk of perioperative MI is related to severity of CAD, left main coronary artery lesion above 50%, presence of congestive heart failure, age above 65 years old and emergency surgery. There is also a high risk of perioperative myocardial infarction in patients who are not previously diagnosed to have CAD as these patients can suffer silent myocardial ischemia and can be asymptomatic during daily life. |
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