Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Internal Medicine

Background:

• Perioperative myocardial injury (PMI) is a recognized contributor to mortality following noncardiac surgery.
• The majority of PMI cases are asymptomatic, leading to underdiagnosis without systematic screening protocols.

Purpose of the Study:

• To investigate the incidence and outcomes of perioperative myocardial injury (PMI) in patients undergoing noncardiac surgery.
• To compare mortality rates between patients with and without PMI, and to assess the impact of diagnostic criteria for acute myocardial infarction on outcomes.

Main Methods:

• A prospective diagnostic study involving consecutive patients at increased cardiovascular risk undergoing noncardiac surgery.
• Systematic screening for PMI using serial high-sensitivity cardiac troponin T measurements.
• PMI defined as an absolute increase of ≥14 ng/L from pre- to post-operative measurements.

Main Results:

• PMI occurred in 16% of 2546 surgeries, with crude 30-day mortality of 8.9% vs. 1.5% in patients without PMI (P<0.001).
• Adjusted hazard ratio for 30-day mortality in patients with PMI was 2.7 (95% CI, 1.5-4.8), with differences persisting at 1 year.
• Thirty-day mortality was comparable between patients with PMI who did and did not meet criteria for spontaneous acute myocardial infarction (10.4% vs. 8.7%, P=0.684).

Conclusions:

• PMI is a frequent complication of noncardiac surgery associated with significant short- and long-term mortality.
• Routine clinical screening effectively detects PMI, highlighting its clinical importance.
• Mortality associated with PMI appears similar regardless of whether additional criteria for spontaneous acute myocardial infarction are met.