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Perioperative myocardial injury common from noncardiac surgery
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Perioperative myocardial injury during noncardiac surgery is common and often leads to poor outcomes, according to a new analysis published in Circulation.
Researchers conducted a prospective diagnostic study of 2,018 consecutive patients considered at high CV risk (median age, 74 years; 42% women) undergoing 2,546 noncardiac surgeries between 2014 and 2015 to assess the frequency of and outcomes related to perioperative myocardial injury.
Perioperative myocardial injury was defined as absolute increase in high-sensitivity cardiac troponin T 14 ng/L from preoperative measurement to postoperative measurement.
The researchers also compared mortality outcomes between patients with perioperative myocardial injury who had additional criteria for a diagnosis of spontaneous acute MI, and those with perioperative myocardial injury who did not have such criteria.
“Patients with [perioperative myocardial injury] are easily missed because they show no symptoms of heart disease in the majority of cases and only very rarely experience chest pain,” Christian Puelacher, MD, PhD, clinical researcher at Cardiovascular Research Institute Basel, Switzerland, said in a press release.
Among the cohort, perioperative myocardial injury occurred in 16% of surgeries (95% CI, 14-17). Among those with perioperative myocardial injury, 6% had typical chest pain and 18% had any ischemic symptoms, according to the researchers.
The crude rate of 30-day mortality was 8.9% (95% CI, 5.7-12) in those with perioperative myocardial injury and 1.5% (95% CI, 0.9-2) in those without it, Puelacher and colleagues found.
A multivariable regression analysis showed that perioperative myocardial injury was an independent predictor of 30-day mortality (HR = 2.7; 95% CI, 1.5-4.8).
One-year mortality rates were also higher in those with perioperative myocardial injury (22.5% [95% CI, 17.6-27.4] vs. 9.3% [95% CI, 7.9-10.7]).
There was no difference between 30-day mortality rates in patients with perioperative myocardial injury but no additional criteria for spontaneous acute MI (10.4%; 95% CI, 6.7-15.7) and those with perioperative myocardial injury but at least one additional criterion for spontaneous acute MI (8.7%; 95% CI, 4.2-16.7; P = .684), according to the researchers.
“Recognizing [perioperative myocardial injury] as a potential contributor to death after surgery might help improve the outcomes of noncardiac surgery,” Puelacher said in the release. “However, since there are no clear treatment recommendations for these patients, treatment currently has to be tailored to each patient individually. Therefore, further research is needed to find optimal [perioperative myocardial injury] management strategies following detection.” – by Erik Swain
Disclosure: Puelacher reports no relevant financial disclosures. Please see the study for a list of the other authors’ relevant financial disclosures.
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