Published: 2021-06-25

A rare presentation of perioperative myocardial infarction as a consequence of stent thrombosis in non-cardiac surgery

Aditi P. Kadakia, Deepak C. Koli, Hemant H. Mehta


Perioperative myocardial infarction (PMI) is a major cause of long term morbidity and mortality associated with non-cardiac surgery. In patients with recent coronary artery stent placement undergoing non-cardiac surgery perioperative management is always challenging. We reported an interesting case of a 67 year old man posted for head neck surgery with recent history of angioplasty with drug eluting stent developing perioperative MI and the challenges faced by an anaesthesiologist.


Perioperative myocardial infarction, Drug eluting stent, Plain old balloon angioplasty, Dual antiplatelets therapy

Full Text:



The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined-a con-sensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J. 2000;21(18):1502-13.

Adams JE, Sicard GA, Allen BT, Bridwell KH, Lenke LG, Román VGD, et al. Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I. N Engl J Med. 1994;330(10):670-4.

Jaffe AS. A small step for man, a leap forward for postoperative management. J Am Coll Cardiol. 2003;42(9):1555-7.

Thygesen K, Alpert JS, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarciton. Universal definition of myocardial infarction. J Am Coll Cardiol. 2007;50(22):2173-95.

Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine. J Am Coll Cardiol. 2014;64(22):77-137.

Darvish-Kazem S, Gandhi M, Marcucci M, Douketis JD. Perioperative management of antiplatelet therapy in patients with a coronary stent who need noncardiac surgery: a systematic review of clinical practice guidelines. Chest. 2013;144(6):1848-56.

Hawn MT, Graham LA, Richman JS, Itani KMF, Henderson WG, Maddox TM. Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents. JAMA. 2013;310(14):1462–-72.

Stevens RD, Burri H, Tramèr MR. Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg. 2003;97(3):623-33.