Long-term outcomes of perioperative myocardial infarction/injury after non-cardiac surgery

Abstract

Aims Perioperative myocardial infarction/injury (PMI) following non-cardiac surgery is a frequent cardiac complication. Better understanding of the underlying aetiologies and outcomes is urgently needed. Methods and results Aetiologies of PMIs detected within an active surveillance and response programme were centrally adjudicated by two independent physicians based on all information obtained during clinically indicated PMI work-up including cardiac imaging among consecutive high-risk patients undergoing major non-cardiac surgery in a prospective multicentre study. PMI aetiologies were hierarchically classified into ‘extra-cardiac’ if caused by a primarily extra-cardiac disease such as severe sepsis or pulmonary embolism; and ‘cardiac’, further subtyped into type 1 myocardial infarction (T1MI), tachyarrhythmia, acute heart failure (AHF), or likely type 2 myocardial infarction (lT2MI). Major adverse cardiac events (MACEs) including acute myocardial infarction, AHF (both only from day 3 to avoid inclusion bias), life-threatening arrhythmia, and cardiovascular death as well as all-cause death were assessed during 1-year follow-up. Among 7754 patients (age 45–98 years, 45% women), PMI occurred in 1016 (13.1%). At least one MACE occurred in 684/7754 patients (8.8%) and 818/7754 patients died (10.5%) within 1 year. Outcomes differed starkly according to aetiology: in patients with extra-cardiac PMI, T1MI, tachyarrhythmia, AHF, and lT2MI 51%, 41%, 57%, 64%, and 25% had MACE, and 38%, 27%, 40%, 49%, and 17% patients died within 1 year, respectively, compared to 7% and 9% in patients without PMI. These associations persisted in multivariable analysis. Conclusion At 1 year, most PMI aetiologies have unacceptably high rates of MACE and all-cause death, highlighting the urgent need for more intensive treatments. Study registration https://clinicaltrials.gov/ct2/show/NCT02573532.

miR-873-5p Suppression Reinvigorates Aging Mesenchymal Stem Cells and Improves Cardiac Repair after Myocardial Infarction

“…Acute myocardial infarction (AMI) is distinguished by myocardial necrosis emanating from severe and lengthy hypoxia and ischemia in the coronary arteries. 1 Although significant advancements have been made in treatments, such as pharmaceutical therapy and percutaneous coronary intervention, AMI continues to be a leading cause of both mortality and morbidity among the elderly population worldwide. The utilization of mesenchymal stem cells (MSCs) in therapy has garnered considerable attention as a promising and emerging approach for treating AMI in recent years.…”

The timing of surgical interventions following the implantation of coronary drug-eluting stents in patients undergoing gastrointestinal cancer surgery: A multicenter retrospective cohort study

“…Additionally, prematurely undergoing surgery for digestive tract cancer after coronary stent placement may lead to increased occurrence of major adverse cardiovascular events (MACEs) postoperatively[9]. Therefore, the timing of digestive tract tumor surgery after coronary stent implantation is crucial, representing a delicate balance between ischemic and bleeding risks during the perioperative period[10–12]. This ultimately determines whether patients can benefit from undergoing surgical intervention earlier[13].…”

Cost-effectiveness of a high-sensitivity cardiac troponin T systematic screening strategy compared with usual care to identify patients with peri-operative myocardial injury after major noncardiac surgery

“…These findings were confirmed for high-sensitivity assays 2,3 and the 1-year time horizon. 4 The fourth universal definition of myocardial infarction 5 mediated myocardial injury, that is that a troponin elevation more than the 99 th percentile is a standalone criterion. The increased awareness of the topic was reflected by a statement by the American Heart Society 6 and by the 2022 guidelines update by the European Society of Cardiology (ESC).…”