ABSTRACT
INTRODUCTION The effects of myocardial ischemia on the heart have been studied for many years. This is not surprising as myocardial ischemia and its consequences are among the leading causes of morbidity and mortality in an increasingly elderly population. Myocardial ischemia is also a major cause of perioperative morbidity and mortality. Indeed, 60% of the patients who die within 30 days of surgery in England, Wales, and Northern Ireland have evidence of coronary heart disease. The number of cardiac deaths is approximately 9000 per annum (1) to which must be added nonfatal complications. On the basis of the literature, the ratio of severe cardiac complications to cardiac death is approximately one in 10 (2). Therefore, the number of adverse cardiac outcomes is likely to be in the region of 100,000 per annum. In the United States, the number of cardiac complications of anesthesia and surgery was approximately 1 million per annum in 1990 (3). As a result of the high prevalence of coronary heart disease, strategies have been developed to reduce the risk of adverse cardiac events in the general population and in surgical patients.
