Myocardial injury after non-cardiac surgery: current state of the problem and unresolved issues

Тhe concept, risk factors, mechanisms, clinical and epidemiological, and angiographic features of perioperative ischemic injury and myocardial infarction were considered. Perioperative myocardial infarction is one of the most common complications (up to 3.6%) in non-cardiac surgical interventions and is characterized by high in-hospital mortality, reaching 25%. Most patients with this pathology (up to 65%) do not have typical symptoms of myocardial ischemia due to anesthesia and sedation. Pathogenetic mechanisms of perioperative myocardial infarction development continues to be actively studied. A critical increase in myocardial oxygen demand is indicated as the leading cause in some studies. Angiography reveals rupture of the coronary plaque and atherothrombosis in more than half of patients, according to other data. These contradictions point to the need for further epidemiological studies using coronary angiography with a focus on risk factors and triggers of this complication. In addition, the concept of perioperative myocardial injury in recent years has been formulated in the scientific literature. This is understood as ischemic damage that occurs in the first 30 days after surgery. Recent studies have shown that it can occur in 16% of surgical patients and is associated with a 6-fold increase in mortality within 1 month after surgery and a 2.5-fold increase within a year. It is important that perioperative myocardial injury does not include cases of non-ischemic etiology myocardial injury, for example, due to pulmonary embolism, sepsis, or electrical cardioversion. Thus, the assessment and understanding of risk factors for the development of perioperative myocardial ischemia is of great practical importance in optimizing the patient selection and preparation for surgical treatment.

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Perioperative infarction and myocardial injury: risk factors, mechanisms of development and clinical and epidemiological features

Shulenin

Черкашин

Solovyev

et al. 2022

Bulletin of the Russian Military Medical Academy

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Comparison of the results of preoperative assessment of cardiovascular risk and outcomes of surgical interventions for locally advanced abdominal cancer

Kutchev

Shulenin

Solovyev

et al. 2023

Bulletin of the Russian Military Medical Academy

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This retrospective study analyzed the structure of complications and mortality cases in 351 patients (men, n = 199; women, n = 152) aged 3389 years with locally advanced abdominal cancer and different cardiovascular risks in the early postoperative period, and two patient groups were formed. The main group consisted of 81 (23.1%) patients who died in the early postoperative period. The comparison group included 270 (76.9%) patients. In total, 311 (88.6%) patients underwent radical surgical intervention, whereas 40 (11.4%) underwent minimally invasive surgical treatment. Perioperative cardiovascular risk was stratified by calculating cardiac risk indices and using the database of the National Program for Improving the Quality of Surgical Care Myocardial Infarction and Cardiac Arrest. Fatal complications in the early postoperative period after surgical treatment of locally advanced abdominal cancer is significantly more often observed in patients with a more pronounced degree of tumor invasion, lymph node lesions, high class according to the standards of the American Society of Anesthesiologists, reduced functional status, prior hormone therapy, and combined anesthesia. The majority of fatal cases were associated with three complications, i.e., ventricular arrhythmias (53%), acute decompensation of heart failure (46%), and multiple organ failure (43%). Approximately 95% of deaths were associated with increased postoperative cardiovascular risk, and 52% were medium-risk cases. Hospital mortality at low risk was noted in 4.9%, average in 27.8%, and high in 32.7% of the patients. In cases with a favorable course, surgical complications were predominant over cardiovascular ones. The use of calculated cardiac risk indices and database of the National Program for Improving the Quality of Surgical Care Myocardial Infarction and Cardiac Arrest confirmed their high ability to predict the development of cardiovascular complications, which are the leading causes of death in the early postoperative period in patients who underwent surgical interventions for locally advanced abdominal cancer.

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Assessment and Correction of the Cardiac Complications Risk in Non-cardiac Operations – What's New?

Sumin

2022

Racionalʹnaâ farmakoterapiâ v kardiologii

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Cardiovascular complications after non-cardiac surgery are the leading cause of 30-day mortality. The need for surgical interventions is approximately 5,000 procedures per 100,000 population, according to experts, the risks of non-cardiac surgical interventions are markedly higher in the elderly. It should be borne in mind that the aging of the population and the increased possibilities of medicine inevitably lead to an increase in surgical interventions in older people. Recent years have been characterized by the appearance of national and international guidelines with various algorithms for assessing and correcting cardiac risk, as well as publications on the validation of these algorithms. The purpose of this review was to provide new information about the assessment and correction of the risk of cardiac complications in non-cardiac operations. Despite the proposed new risk assessment scales, the RCRI scale remains the most commonly used, although for certain categories of patients (with oncopathology, in older age groups) the possibility of using specific questionnaires has been shown. In assessing the functional state, it is proposed to use not only a subjective assessment, but also the DASI questionnaire, 6-minute walking test and cardiopulmonary exercise test). At the next stage, it is proposed to evaluate biomarkers, primarily BNP or NT-proBNP, with a normal level – surgery, with an increased level – either an additional examination by a cardiologist or perioperative troponin screening. Currently, the prevailing opinion is that there is no need to examine patients to detect hidden lesions of the coronary arteries (non-invasive tests, coronary angiography), since this leads to excessive examination of patients, delaying the implementation of non-cardiac surgery. The extent to which this approach has an advantage over the previously used one remains to be studied.

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Myocardial injury after non-cardiac surgery: current state of the problem and unresolved issues

Cited by 3 publications

References 66 publications

Perioperative infarction and myocardial injury: risk factors, mechanisms of development and clinical and epidemiological features

Perioperative infarction and myocardial injury: risk factors, mechanisms of development and clinical and epidemiological features

Comparison of the results of preoperative assessment of cardiovascular risk and outcomes of surgical interventions for locally advanced abdominal cancer

Assessment and Correction of the Cardiac Complications Risk in Non-cardiac Operations – What's New?

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