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Published on: June 11, 2020
Perioperative Myocardial Infarction in Non-Cardiac Surgery Patients: A Prospective Observational Study
A Ollila1,2, L Vikatmaa2, J Virolainen3
11 Department of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Insights
Perioperative myocardial infarction (PMI) is common in non-cardiac surgery patients, affecting 7.0% and increasing 90-day mortality to 29.6%. Routine use of the perioperative risk calculator is supported for predicting PMI.
Area of Science:
- Cardiology
- Perioperative Medicine
- Critical Care
Background:
- Perioperative myocardial infarction (PMI) is an underdiagnosed complication with significant morbidity, mortality, and healthcare costs.
- Limited evidence exists regarding preventive and therapeutic strategies for PMI.
Purpose of the Study:
- To investigate the incidence and outcomes of PMI in patients undergoing non-cardiac surgery.
- To identify a target population for future interventional trials on PMI.
Main Methods:
- Prospective single-center study of 385 non-cardiac surgery patients aged 50 years or older.
- Systematic ischemia screening using high-sensitivity troponin T and electrocardiography.
- PMI diagnosis required troponin T release and ischemic signs/symptoms; perioperative risk calculator used for risk assessment.
Main Results:
- The incidence of PMI was 7.0% (27/385 patients), highest in vascular surgery (11.0%).
- 90-day mortality was significantly higher in patients with PMI (29.6%) versus without (5.6%; p < 0.001).
- The perioperative risk calculator demonstrated fair predictive ability for PMI (AUC 0.73).
Conclusions:
- PMI is a frequent complication of non-cardiac surgery with a nearly 30% 90-day mortality rate.
- The perioperative risk calculator's fair predictive performance supports its routine clinical use for risk assessment.
Background And Aims:
Perioperative myocardial infarction is an underdiagnosed complication causing morbidity, mortality, and considerable costs. However, evidence of preventive and therapeutic options is scarce. We investigated the incidence and outcome of perioperative myocardial infarction in non-cardiac surgery patients in order to define a target population for future interventional trials.
Material And Methods:
We conducted a prospective single-center study on non-cardiac surgery patients aged 50 years or older. High-sensitivity troponin T and electrocardiograph were obtained five times perioperatively. Perioperative myocardial infarction diagnosis required a significant troponin T release and an ischemic sign or symptom. Perioperative risk calculator was used for risk assessment.
Results:
Of 385 patients with systematic ischemia screening, 27 patients (7.0%) had perioperative myocardial infarction. The incidence was highest in vascular surgery-19 of 172 patients (11.0%). The 90-day mortality was 29.6% in patients with perioperative myocardial infarction and 5.6% in non-perioperative myocardial infarction patients ( p < 0.001). Perioperative risk calculator predicted perioperative myocardial infarction with an area under curve of 0.73 (95% confidence interval: 0.64-0.81).
Conclusion:
Perioperative myocardial infarction is a common complication associated with a 90-day mortality of 30%. The ability of the perioperative risk calculator to predict perioperative myocardial infarction was fair supporting its routine use.
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