LAUSR

Circulation. 2018;138:1076. DOI: 10.1161/CIRCULATIONAHA.118.035685 1076 Lei Wang, MD Yun-Tao Zhao, MD, PhD To the Editor: We read with great interest the article presented by Christian Puelacher and colleagues1 about perioperative myocardial injury (PMI). In Puelacher et al’s study, PMI occurred in 16% of all surgeries and was associated with nearly 3-fold higher 30day mortality risk and 1.6-fold higher 1-year mortality risk. Among cases of PMI, only 6% had typical anginal chest pain and 18% had any symptoms of ischemia. Furthermore, 30-day mortality was similar between cases of PMI with and without symptoms. For patients with PMI, cardiomyocyte injury seemed to be caused by supply–demand mismatch attributable to hypotension, anemia, and tachycardia rather than plaque rupture. Is the increasing of mortality related to PMI? Or does PMI only reflect the surgical risk itself? Major surgery can cause many organ injures, cardiomyocyte injury among them; PMI indicates that the surgery is high risk and it’s the manifestation of surgical risk not the reason of mortality increasing.