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Myocardial injury and its prevention in the perioperative setting.

In the UK, there are ~20 000 deaths within 30 days of surgery every year, 9000 of which have a cardiac cause. The number of major cardiac complications is likely to be in the region of 150 000 per annum. As 60% of patients who die within 30 days of surgery suffer from coronary artery disease it is reasonable to assume that the majority of cardiac complications of anaesthesia and surgery results from myocardial ischaemia leading to myocardial injury (Fig. 1).