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Unexpected Cardiac Computed Tomography Findings in Patients With Postoperative Myocardial Injury
Remco B Grobben1,2, Judith A R van Waes2, Tim Leiner3
1From the Departments of Cardiology.
Insights
Postoperative myocardial injury (PMI) after noncardiac surgery is linked to coronary artery disease (CAD). This study found CAD in 50% of patients with PMI, highlighting the need for further cardiac evaluation.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Postoperative myocardial injury (PMI) is a significant predictor of mortality following noncardiac surgery.
- The precise causes of PMI remain unclear, though coronary artery disease (CAD) is suspected.
- Quantifying significant CAD in patients experiencing PMI is crucial for understanding its etiology.
Purpose of the Study:
- To determine the prevalence of significant coronary artery disease (CAD) in patients who experienced postoperative myocardial injury (PMI) after noncardiac surgery.
- To compare the prevalence of CAD in patients with and without PMI.
- To investigate the utility of coronary computed tomography angiography (CCTA) in assessing CAD in this population.
Main Methods:
- A prospective cohort study involving patients aged 60 years or older undergoing intermediate- to high-risk noncardiac surgery.
- Patients with and without postoperative myocardial injury (PMI), defined by troponin I levels ≥60 ng/L, were included.
- Coronary computed tomography angiography (CCTA) was performed postoperatively to assess for significant coronary artery disease (>50% stenosis).
Main Results:
- Coronary artery disease (CAD) was identified in 50% of patients with PMI compared to 15% of controls (relative risk, 3.3).
- Pulmonary embolism was incidentally detected in 33% of patients with PMI versus 20% of controls.
- No 30-day mortality was observed in the study cohort.
Conclusions:
- Postoperative myocardial injury (PMI) in patients without prior cardiac history undergoing noncardiac surgery is associated with underlying coronary artery disease (CAD).
- Clinically silent pulmonary embolism was a notable finding in a significant proportion of patients with PMI.
- These findings underscore the importance of further research into advanced imaging techniques for improved clinical assessment and management.
Background:
Postoperative myocardial injury (PMI) is a strong predictor of mortality after noncardiac surgery. PMI is believed to be attributable to coronary artery disease (CAD), yet its etiology is largely unclear. We aimed to quantify the prevalence of significant CAD in patients with and without PMI using coronary computed tomography angiography (CCTA).
Methods:
This prospective cohort study included patients of 60 years or older without a history of cardiac disease and with and without PMI after intermediate- to high-risk noncardiac surgery. PMI was defined as any serum troponin I level ≥60 ng/L on the first 3 postoperative days. Main exclusion criteria were known cardiac disease and postoperative ischemic symptoms or electrocardiography abnormalities. Noninvasive imaging consisted of a postoperative CCTA. Main outcome was CAD defined as >50% coronary stenosis on CCTA.
Results:
The analysis included 66 patients. Median peak troponin levels in the PMI (n = 46) and control group (n = 20) were 150 (interquartile range, 120-298) vs 15 (interquartile range, 10-31) ng/L (P < .01). CAD was found in 23 patients with PMI (50%) vs 3 without PMI (15%; relative risk, 3.3; 95% confidence interval, 1.1-9.8). Remarkably, pulmonary embolism was present in 15 patients with PMI (33%) versus in 4 without PMI (20%; relative risk, 1.6; 95% confidence interval, 0.6-4.3). None of the patients died within 30 days.
Conclusions:
In patients without a history of cardiac disease, PMI after noncardiac surgery was associated with CAD. In addition, a clinically silent pulmonary embolism was found in one-third of patients with PMI. This urges further research to improve clinical workup using imaging and may have important clinical implications.
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