Intraoperative Hypotension and Myocardial Infarction Development Among High-Risk Patients Undergoing Noncardiac Surgery

A Nested Case-Control Study

Linn Hallqvist, MD, PhD Student, DESA; Fredrik Granath, PhD; Michael Fored, MD, PhD; Max Bell, MD, PhD


Anesth Analg. 2021;133(1):6-15. 

In This Article


In this case-control study, nested within a well-defined cohort of high-risk noncardiac surgical patients, IOH was identified as an important risk factor for MI development in the perioperative period. A decrease in systolic BP of 50 mm Hg, for at least 5 minutes, from preoperative individual resting baseline, was strongly associated with perioperative MI. However, even though the relative risk of clinically manifested MI associated with a large fall in BP was 20-fold, this corresponds to low absolute excess risk for the majority of operated patients. For patients with very high preoperative risk burden, the associated absolute excess risk was estimated to 6%. Long-term mortality was increased with doubled mortality rates up to 1 year postsurgery, among patients surviving the first 3 postsurgery.