Myocardial injury after non-cardiac surgery

Perioperative myocardial injury in patients undergoing non-cardiac surgery is a major challenge in the vascular surgical practice. It can be missed if we don’t look for it, but it was found to be associated with early (30-day) and late (1 yr) morbidity and mortality. Puelacher C et al defined Perioperative Myocardial Infarction (PMI) as an absolute high-sensitivity cardiac troponin T increase of ≥14 ng/L from preoperative to postoperative measurements. In their large study (2546 surgeries) PMI occurred in 16%, but it was accompanied by chest pain only in 6%, any type of ischemic symptoms in 18%. Crude 30-day mortality was 8.9%  in patients with PMI versus 1.5% in patients without PMI. There is a potential to help many of the 8 million adults globally who have PMI(MINS) to reduce their risk of a major vascular complication. If only we can identify these patients and apply appropriate medications, we can prevent this mortality and morbidity.

Reference

Puelacher C, Lurati Buse G, Seeberger D, Sazgary L, Marbot S, Lampart A, Espinola J, Kindler C, Hammerer A, Seeberger E, Strebel I, Wildi K, Twerenbold R, du Fay de Lavallaz J, Steiner L, Gurke L, Breidthardt T, Rentsch K, Buser A, Gualandro DM, Osswald S, Mueller C; BASEL-PMI Investigators. Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization. Circulation. 2018;137(12):1221-1232.