{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:34:56Z","timestamp":1787567696597,"version":"build-2736575974"},"reference-count":71,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Globally, approximately three hundred million individuals undergo non-cardiac surgery each year. Perioperative mortality results from a complex interplay between patient-related factors and procedural variables, including both surgical and anesthetic aspects. Although cardiac surgery has a well-established risk profile for acute cardiovascular events, major non-cardiac surgery also carries significant\u2014yet often underrecognized\u2014cardiovascular risks. Approximately half of postoperative deaths following non-cardiac procedures are attributable to cardiovascular complications. Surgical and anesthetic stress responses may induce myocardial injury through several pathophysiological mechanisms. However, the absence of a universally accepted definition of perioperative myocardial injury complicates both diagnosis and management. Furthermore, these injuries frequently occur without symptoms, making them clinically silent and often undetected. Consequently, unexpected postoperative deaths may occur and may lead to allegations of medical malpractice. We conducted a narrative review of existing literature on perioperative myocardial injury and its implications for forensic investigation and medico-legal assessment. This paper highlights the importance of a comprehensive forensic evaluation of perioperative deaths, integrating clinical documentation, autopsy findings, histopathological evidence and ancillary investigations to support accurate medico-legal assessment, recognizing that no single element is sufficient to establish the cause of death in all cases. Four illustrative case studies are presented to demonstrate the medico-legal challenges associated with these events. A structured forensic investigation is essential for accurately determining the cause of death and for distinguishing preventable medical errors from unavoidable adverse outcomes within the context of complex perioperative care.<\/jats:p>","DOI":"10.3390\/diagnostics16172692","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:20:02Z","timestamp":1787563202000},"page":"2692","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Forensic Approach to Perioperative Deaths After Non-Cardiac Surgery: A Narrative Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6299-9900","authenticated-orcid":false,"given":"Lucia","family":"Tattoli","sequence":"first","affiliation":[{"name":"Section of Legal Medicine, Department of Sciences of Public Health and Pediatrics, University of Turin, Corso Galileo Galilei 22, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6967-6591","authenticated-orcid":false,"given":"Agnese","family":"Accogli","sequence":"additional","affiliation":[{"name":"Section of Legal Medicine, Department of Sciences of Public Health and Pediatrics, University of Turin, Corso Galileo Galilei 22, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Montana","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, University Polytechnical delle Marche, Via Tronto, 10\/a, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Pradelle","sequence":"additional","affiliation":[{"name":"Section of Legal Medicine, University of Modena e Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2833-2835","authenticated-orcid":false,"given":"Andrea","family":"De Gasperi","sequence":"additional","affiliation":[{"name":"Anesthesia CCM 2, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell\u2019Ospedale Maggiore 3, 20162 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6459-1669","authenticated-orcid":false,"given":"Margherita","family":"Neri","sequence":"additional","affiliation":[{"name":"Section of Legal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/CRD.0000000000000254","article-title":"Myocardial Injury After Noncardiac Surgery: A Systematic Review and Meta-Analysis","volume":"27","author":"Smilowitz","year":"2019","journal-title":"Cardiol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e351","DOI":"10.1161\/CIR.0000000000001285","article-title":"2024 AHA\/ACC\/ACS\/ASNC\/HRS\/SCA\/SCCT\/SCMR\/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"150","author":"Thompson","year":"2024","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.mayocpiqo.2024.07.002","article-title":"Perioperative Mortality: A Retrospective Cohort Study of 75,446 Noncardiac Surgery Patients","volume":"8","author":"Nuttall","year":"2024","journal-title":"Mayo Clin. Proc. Innov. Qual. Outcomes"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e287","DOI":"10.1161\/CIR.0000000000001024","article-title":"Diagnosis and Management of Patients With Myocardial Injury After Noncardiac Surgery: A Scientific Statement From the American Heart Association","volume":"144","author":"Ruetzler","year":"2021","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pusceddu, E., Pintus, B.M., Baldini, G., Deana, C., Pavoni, V., Pilia, E., Testa, G.D., Bellini, V., Marciano, E., and Romagnoli, S. (2026). Assessment and Optimization of Cardiovascular Risk and Frailty Before Noncardiac Surgery: A Comparative Analysis of Recent European and American Guidelines. J. Cardiothorac. Vasc. Anesth., in press.","DOI":"10.1053\/j.jvca.2026.07.005"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1053\/j.jvca.2024.09.149","article-title":"Navigating Cardiovascular Events in Non-Cardiac Surgery: A Comprehensive Review of Complications and Risk Assessment Strategies","volume":"39","author":"Shuja","year":"2025","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1515\/cclm-2022-0481","article-title":"Evaluation of the Cardiovascular Risk in Patients Undergoing Major Non-Cardiac Surgery: Role of Cardiac-Specific Biomarkers: A Consensus Document by the Inter-Society Study Group on Cardiac Biomarkers of the Italian Societies of Clinical Biochemistry: European Ligand Assay Society (ELAS), Italian Section; Societ\u00e0 Italiana Di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC); Societ\u00e0 Italiana Di Patologia Clinica e Medicina Di Laboratorio (SIPMel)","volume":"60","author":"Clerico","year":"2022","journal-title":"Clin. Chem. Lab. Med. (CCLM)"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.bja.2024.07.012","article-title":"Visualising Myocardial Injury After Noncardiac Surgery: A Case Series Using Postoperative Cardiovascular MRI","volume":"133","author":"Guensch","year":"2024","journal-title":"Br. J. Anaesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1016\/j.jacc.2020.08.043","article-title":"Etiology of Peri-Operative Myocardial Infarction\/Injury After Noncardiac Surgery and Associated Outcome","volume":"76","author":"Puelacher","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/ALN.0000000000000113","article-title":"Myocardial Injury After Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-Day Outcomes","volume":"120","author":"Botto","year":"2014","journal-title":"Anesthesiology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1161\/CIRCULATIONAHA.117.030114","article-title":"Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization","volume":"137","author":"Puelacher","year":"2018","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1016\/j.mayocp.2019.08.013","article-title":"Preoperative Cardiac Risk Assessment","volume":"95","author":"Raslau","year":"2020","journal-title":"Mayo Clin. Proc."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Rostagno, C., and Craighero, A. (2024). Postoperative Myocardial Infarction After Non-Cardiac Surgery: An Update. J. Clin. Med., 13.","DOI":"10.20944\/preprints202401.1777.v1"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Peden, C.J., Fleisher, L.A., and Englesbe, M. (2023). Chapter 3\u2014What Is Perioperative Medicine and Why Do We Need It?. Perioperative Quality Improvement, Elsevier.","DOI":"10.1016\/B978-0-323-83399-8.00038-7"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3079","DOI":"10.1016\/j.jacc.2019.04.024","article-title":"Pre-Operative Risk Prediction","volume":"73","author":"Eagle","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators, Devereaux, P.J., Chan, M.T.V., Alonso-Coello, P., Walsh, M., Berwanger, O., Villar, J.C., Wang, C.Y., Garutti, R.I., and Jacka, M.J. (2012). Association Between Postoperative Troponin Levels and 30-Day Mortality among Patients Undergoing Noncardiac Surgery. JAMA, 307, 2295\u20132304.","DOI":"10.1001\/jama.2012.5502"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E661","DOI":"10.1503\/cmaj.231355","article-title":"Myocardial Injury After Noncardiac Surgery","volume":"196","author":"Kulkarni","year":"2024","journal-title":"Can. Med. Assoc. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/j.amjmed.2021.07.016","article-title":"Reevaluating the Cardiac Risk of Noncardiac Surgery Using the National Surgical Quality Improvement Program","volume":"134","author":"Peterson","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3826","DOI":"10.1093\/eurheartj\/ehac270","article-title":"2022 ESC Guidelines on Cardiovascular Assessment and Management of Patients Undergoing Non-Cardiac Surgery","volume":"43","author":"Halvorsen","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1097\/ALN.0000000000002341","article-title":"Impact of the Choice of Risk Model for Identifying Low-Risk Patients Using the 2014 American College of Cardiology\/American Heart Association Perioperative Guidelines","volume":"129","author":"Glance","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_21","first-page":"17","article-title":"Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery","volume":"33","author":"Duceppe","year":"2017","journal-title":"Can. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.bja.2020.06.016","article-title":"A Simplified (Modified) Duke Activity Status Index (M-DASI) to Characterise Functional Capacity: A Secondary Analysis of the Measurement of Exercise Tolerance Before Surgery (METS) Study","volume":"126","author":"Riedel","year":"2021","journal-title":"Br. J. Anaesth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.23736\/S0375-9393.19.13584-5","article-title":"Clinical Guidelines for Perioperative Hemodynamic Management of Non Cardiac Surgical Adult Patients","volume":"85","author":"Brienza","year":"2019","journal-title":"Minerva Anestesiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.bjae.2024.06.001","article-title":"Perioperative Myocardial Injury","volume":"24","author":"Hughes","year":"2024","journal-title":"BJA Educ."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bosco, E., Hsueh, L., McConeghy, K.W., Gravenstein, S., and Saade, E. (2021). Major Adverse Cardiovascular Event Definitions Used in Observational Analysis of Administrative Databases: A Systematic Review. BMC Med. Res. Methodol., 21.","DOI":"10.1186\/s12874-021-01440-5"},{"key":"ref_26","first-page":"550","article-title":"Incidence of Major Adverse Cardiac Events Following Non-Cardiac Surgery","volume":"10","author":"Sazgary","year":"2021","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"ehae666.1556","DOI":"10.1093\/eurheartj\/ehae666.1556","article-title":"Insights into the Reporting of Major Adverse Cardiovascular Events in Coronary Artery Disease Trials","volume":"45","author":"Lee","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.carrev.2024.06.004","article-title":"Examining Patient Demographics and Major Adverse Cardiac Events Following Noncardiac Surgery: Applying a Health Equity Lens","volume":"68","author":"Smith","year":"2024","journal-title":"Cardiovasc. Revasc. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kashlan, B., Kinno, M., and Syed, M. (2024). Perioperative Myocardial Injury and Infarction after Noncardiac Surgery: A Review of Pathophysiology, Diagnosis, and Management. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1323425"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.bja.2019.04.041","article-title":"Systematic Review and Consensus Definitions for the Standardised Endpoints in Perioperative Medicine Initiative: Clinical Indicators","volume":"123","author":"Haller","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.bja.2020.08.041","article-title":"Association Between Self-Reported Functional Capacity and Major Adverse Cardiac Events in Patients at Elevated Risk Undergoing Noncardiac Surgery: A Prospective Diagnostic Cohort Study","volume":"126","author":"Buse","year":"2021","journal-title":"Br. J. Anaesth."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Popova, E., Paniagua-Iglesias, P., \u00c1lvarez-Garc\u00eda, J., Vives-Borr\u00e1s, M., Gonz\u00e1lez-Osuna, A., Garc\u00eda-Osuna, \u00c1., Rivas-Lasarte, M., Hermenegildo-Chavez, G., Diaz-Jover, R., and Azparren-Cabezon, G. (2023). The Relevance of Implementing the Systematic Screening of Perioperative Myocardial Injury in Noncardiac Surgery Patients. J. Clin. Med., 12.","DOI":"10.3390\/jcm12165371"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1097\/EJA.0000000000001486","article-title":"Expert Consensus on Peri-Operative Myocardial Injury Screening in Noncardiac Surgery: A Literature Review","volume":"38","author":"Puelacher","year":"2021","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/ACO.0000000000000981","article-title":"Myocardial Injury after Noncardiac Surgery\u2014An Update","volume":"34","author":"Szczeklik","year":"2021","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Cicek, V., Babaoglu, M., Saylik, F., Yavuz, S., Mazlum, A.F., Genc, M.S., Altinisik, H., Oguz, M., Korucu, B.C., and Hayiroglu, M.I. (2024). A New Risk Prediction Model for the Assessment of Myocardial Injury in Elderly Patients Undergoing Non-Elective Surgery. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12010006"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1093\/eurheartj\/ehz301","article-title":"Myocardial Injury after Non-Cardiac Surgery: Diagnosis and Management","volume":"41","author":"Devereaux","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e005672","DOI":"10.1161\/JAHA.117.005672","article-title":"Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long-Term Mortality After Noncardiac Vascular Surgery","volume":"6","author":"Reed","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_38","first-page":"729","article-title":"Prediction of Perioperative Myocardial Infarction\/Injury in High-Risk Patients after Noncardiac Surgery","volume":"12","author":"Meister","year":"2023","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_39","first-page":"1215","article-title":"Predicting Myocardial Injury and Other Cardiac Complications After Elective Noncardiac Surgery with the Revised Cardiac Risk Index: The VISION Study","volume":"37","author":"Roshanov","year":"2021","journal-title":"Can. J. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e019379","DOI":"10.1161\/JAHA.120.019379","article-title":"Postoperative Myocardial Injury in Patients Classified as Low Risk Preoperatively Is Associated with a Particularly Increased Risk of Long-Term Mortality After Noncardiac Surgery","volume":"10","author":"Vasireddi","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_41","first-page":"740","article-title":"Utility of Pre-Operative Cardiac Biomarkers to Predict Myocardial Infarction and Injury After Non-Cardiac Surgery","volume":"12","author":"Devereaux","year":"2023","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1136\/jim-2018-000916","article-title":"Atrial Dysplasia in the Atria of Humans Without Cardiovascular Disease","volume":"67","author":"Li","year":"2019","journal-title":"J. Investig. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s10006-016-0567-0","article-title":"Sudden Death After Major Head and Neck Cancer Surgery Due to Undetected Arrhythmogenic Right Ventricle Cardiomyopathy (ARVC)","volume":"20","author":"Jellen","year":"2016","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_44","first-page":"28","article-title":"Arrhythmogenic Right Ventricular Dysplasia and Sudden Cardiac Death in Endurance Athletes","volume":"11","author":"Hoogsteen","year":"2003","journal-title":"Neth. Heart J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s00428-019-02662-1","article-title":"Diagnosis of Myocardial Infarction at Autopsy: AECVP Reappraisal in the Light of the Current Clinical Classification","volume":"476","author":"Michaud","year":"2020","journal-title":"Virchows Arch."},{"key":"ref_46","first-page":"122","article-title":"Presence of Intramyocardial Fat Tissue in the Right Atrium and Right Ventricle\u2014Postmortem Human Analysis","volume":"57","year":"2018","journal-title":"Acta Clin. Croat."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"De Coster, T., Claus, P., Seemann, G., Willems, R., Sipido, K.R., and Panfilov, A.V. (2018). Myocyte Remodeling Due to Fibro-Fatty Infiltrations Influences Arrhythmogenicity. Front. Physiol., 9.","DOI":"10.3389\/fphys.2018.01381"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1213\/ANE.0000000000004133","article-title":"Safety of Beach Chair Position Shoulder Surgery: A Review of the Current Literature","volume":"129","author":"Murphy","year":"2019","journal-title":"Anesth. Analg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.bjae.2018.12.004","article-title":"Regional Anaesthesia for Shoulder Surgery","volume":"19","author":"Hewson","year":"2019","journal-title":"BJA Educ."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.jclinane.2004.09.012","article-title":"Cerebral Ischemia during Shoulder Surgery in the Upright Position: A Case Series","volume":"17","author":"Pohl","year":"2005","journal-title":"J. Clin. Anesth."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1213\/XAA.0000000000001027","article-title":"Early Recognition of a Transient Ischemic Attack Utilizing Cerebral Oxygenation Monitoring During Shoulder Surgery in the Beach Chair Position: A Case Report","volume":"13","author":"Aguirre","year":"2019","journal-title":"A A Pract."},{"key":"ref_52","first-page":"219","article-title":"Anesthesia for the Patient Undergoing Shoulder Surgery","volume":"42","author":"Mojica","year":"2024","journal-title":"Clin. Sports Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/HCO.0000000000000069","article-title":"Myocardial Injury after Noncardiac Surgery","volume":"29","author":"Khan","year":"2014","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1213\/ANE.0000000000004567","article-title":"Myocardial Injury After Noncardiac Surgery: Preoperative, Intraoperative, and Postoperative Aspects, Implications, and Directions","volume":"131","author":"Ruetzler","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Sacco, M.A., Gualtieri, S., Grimaldi, G., Monterossi, M.D., Aquila, V.R., Tarallo, A.P., Verrina, M.C., Ranno, F., Gratteri, S., and Aquila, I. (2024). The Role of Cardiac Troponins in Postmortem Diagnosis of Myocardial Ischemia: A Systematic Review. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26010105"},{"key":"ref_56","first-page":"e70841","article-title":"Guidelines for Scrutiny of Death Associated with Surgery and Anesthesia","volume":"16","author":"Mostafa","year":"2024","journal-title":"Cureus"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"486","DOI":"10.47102\/annals-acadmedsg.V29N4p486","article-title":"Perioperative Deaths: A Further Comparative Review of Coroner\u2019s Autopsies with Particular Reference to the Occurrence of Fatal Iatrogenic Injury","volume":"29","author":"Lau","year":"2000","journal-title":"Ann. Acad. Med. Singap."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"813","DOI":"10.55248\/gengpi.6.0625.2027","article-title":"Intraoperative Cardiac Arrest: Diagnostic Considerations and Management: A Case Report with Literature Review","volume":"6","author":"Ouzzaouit","year":"2025","journal-title":"Int. J. Res. Publ. Rev."},{"key":"ref_59","first-page":"e95805","article-title":"Post-Surgical Autopsy Findings: Insights Into Forensic Evaluation and Surgical Complications","volume":"17","author":"Reddy","year":"2025","journal-title":"Cureus"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s004140100229","article-title":"Myocardial Contraction Bands","volume":"115","author":"Baroldi","year":"2001","journal-title":"Int. J. Leg. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"7018393","DOI":"10.1155\/2017\/7018393","article-title":"Ischemia\/Reperfusion Injury Following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists","volume":"2017","author":"Neri","year":"2017","journal-title":"Mediat. Inflamm."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1007\/s00414-025-03479-1","article-title":"Ischemic and Non-Ischemic Myocardial Injuries at Autopsy\u2014An Overview for Forensic Pathologists","volume":"139","author":"Michaud","year":"2025","journal-title":"Int. J. Leg. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.mpdhp.2019.07.007","article-title":"An Approach to the Autopsy Examination of Patients Who Die During Surgery or in the Post-Operative Period","volume":"25","author":"Burton","year":"2019","journal-title":"Diagn. Histopathol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/20961790.2019.1630944","article-title":"Postmortem Imaging as a Complementary Tool for the Investigation of Cardiac Death","volume":"4","author":"Michaud","year":"2019","journal-title":"Forensic Sci. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1093\/jat\/bkae052","article-title":"Difficulties Associated with the Interpretation of Postmortem Toxicology","volume":"48","author":"Stephenson","year":"2024","journal-title":"J. Anal. Toxicol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1053\/j.sult.2018.10.012","article-title":"Postmortem Imaging: An Update","volume":"40","author":"Cafarelli","year":"2019","journal-title":"Semin. Ultrasound CT MRI"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e240192","DOI":"10.1148\/rg.240192","article-title":"Postmortem CT: Applications in Clinical and Forensic Medicine","volume":"45","author":"Solomon","year":"2025","journal-title":"RadioGraphics"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1097\/00003643-200004000-00004","article-title":"Unsuspected Cardiac Lesions Associated with Sudden Unexpected Perioperative Death","volume":"17","author":"Tabib","year":"2000","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_69","unstructured":"Parlamento Italiano (Italian Parliament) (2017). Legge 8 Marzo 2017, n. 24. Disposizioni in Materia di Sicurezza Delle Cure e della Persona Assistita, Nonch\u00e9 in Materia di Responsabilit\u00e0 Professionale Degli Esercenti le Professioni Sanitarie (Law No. 24 of 8 March 2017: Provisions on Patient Safety and the Safety of Healthcare, as Well as the Professional Liability of Healthcare Professionals)."},{"key":"ref_70","unstructured":"Academy of Medical Royal Colleges (2019). Acting as an Expert or Professional Witness: Guidance for Healthcare Professionals, Academy of Medical Royal Colleges. Available online: https:\/\/www.aomrc.org.uk\/."},{"key":"ref_71","unstructured":"Acad\u00e9mie Nationale de M\u00e9decine (2011). Comp\u00e9tence Scientifique et Technique de L\u2019expert et Qualit\u00e9 de L\u2019expertise en Responsabilit\u00e9 M\u00e9dicale, Acad\u00e9mie Nationale de M\u00e9decine. 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