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Perioperative myocardial necrosis in patients at high cardiovascular risk undergoing elective non-cardiac surgery

Richard F Alcock1, Dorothy Kouzios, Christopher Naoum

  • 1Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia.

Heart (British Cardiac Society)
|May 1, 2012
PubMed

Insights

Perioperative myocardial necrosis is common in patients undergoing non-cardiac surgery, often undetected. Age and intraoperative hypotension are key predictors of this cardiac muscle damage.

Area of Science:

  • Cardiology
  • Perioperative Medicine
  • Cardiac Biomarkers

Background:

  • Cardiovascular complications are significant causes of morbidity and mortality in patients undergoing non-cardiac surgery.
  • Diagnosing perioperative myocardial infarction (MI) can be challenging, yet it carries prognostic importance.
  • High-sensitivity troponin T (hs-TnT) assays enable the detection of minor cardiac muscle damage, but their perioperative utility requires further evaluation.

Purpose of the Study:

  • To determine the incidence of myocardial necrosis in patients at high cardiovascular risk undergoing elective non-cardiac surgery.
  • To identify predictors of myocardial necrosis using high-sensitivity troponin T (hs-TnT) assays in this patient population.
  • To evaluate the relationship between preoperative hs-TnT levels and perioperative myocardial events.

Main Methods:

  • A prospective observational cohort study was conducted.
  • 352 consecutive patients undergoing elective major non-cardiac surgery, who were prescribed antiplatelet therapy, were included.
  • The incidence of elevated preoperative hs-TnT, hs-TnT-defined perioperative myocardial necrosis, and perioperative MI were assessed in relation to patient and surgical factors.

Main Results:

  • Elevated preoperative hs-TnT was observed in 31% of patients, and 22% experienced postoperative myocardial necrosis.
  • Independent predictors of perioperative myocardial necrosis included advanced age, intraoperative hypotension, and undergoing orthopaedic surgery.
  • Clinically apparent MI occurred in only 2% of patients, and elevated preoperative hs-TnT did not predict perioperative myocardial necrosis or MI.

Conclusions:

  • Perioperative myocardial damage is frequent in patients undergoing elective non-cardiac surgery, with most events being clinically silent.
  • Age and intraoperative hypotension are identified as independent predictors of myocardial necrosis in this high-risk surgical population.
  • The study highlights the prevalence of subclinical myocardial injury and the importance of monitoring cardiac biomarkers in the perioperative period.
Abstract

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