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

• Published in: Circulation (New York, N.Y.) N.Y.), 2018-03, Vol.137 (12), p.1221-1232
• Main Authors: Puelacher, Christian, Lurati Buse, Giovanna, Seeberger, Daniela, Sazgary, Lorraine, Marbot, Stella, Lampart, Andreas, Espinola, Jaqueline, Kindler, Christoph, Hammerer, Angelika, Seeberger, Esther, Strebel, Ivo, Wildi, Karin, Twerenbold, Raphael, du Fay de Lavallaz, Jeanne, Steiner, Luzius, Gurke, Lorenz, Breidthardt, Tobias, Rentsch, Katharina, Buser, Andreas, Gualandro, Danielle M, Osswald, Stefan, Mueller, Christian, Seeberger, Manfred, Christ-Crain, Mirjam, Cuculi, Florim, Badertscher, Patrick, Nestelberger, Thomas, Wussler, Desiree, Flores, Dayana, Boeddinghaus, Jasper, Sabti, Zaid, Giménez, Maria Rubini, Kozhuharov, Nikola, Shrestha, Samyut, Kloos, Wanda, Lohrmann, Jens, Reichlin, Tobias, Freese, Michael, Meissner, Kathrin, Kaiser, Christoph
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.117.030114

BACKGROUND:Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening. METHODS:We performed a prospective diagnostic study enrolling consecutive patients undergoing noncardiac surgery who had a planned postoperative stay of ≥24 hours and were considered at increased cardiovascular risk. All patients received a systematic screening using serial measurements of high-sensitivity cardiac troponin T in clinical routine. PMI was defined as an absolute high-sensitivity cardiac troponin T increase of ≥14 ng/L from preoperative to postoperative measurements. Furthermore, mortality was compared among patients with PMI not fulfilling additional criteria (ischemic symptoms, new ECG changes, or imaging evidence of loss of viable myocardium) required for the diagnosis of spontaneous acute myocardial infarction versus those that did. RESULTS:From 2014 to 2015 we included 2018 consecutive patients undergoing 2546 surgeries. Patients had a median age of 74 years and 42% were women. PMI occurred after 397 of 2546 surgeries (16%; 95% confidence interval, 14%–17%) and was accompanied by typical chest pain in 24 of 397 patients (6%) and any ischemic symptoms in 72 of 397 (18%). Crude 30-day mortality was 8.9% (95% confidence interval [CI], 5.7–12.0) in patients with PMI versus 1.5% (95% CI, 0.9–2.0) in patients without PMI (P