Myocardial Injury After Noncardiac Surgery and its Association With Short-Term Mortality

Abstract

The prevalence of vascular disease in each vascular territory also increased with age. After adjustment for sex, race-ethnicity, body mass index, family history of cardiovascular disease, smoking, diabetes, hypertension, hypercholesterolemia, and exercise, the odds of PAD (odds ratio [OR], 2.14; 95% confidence interval [CI], 2.12-2.15), carotid artery stenosis (OR, 1.8; 95% CI, 1.79-1.81), and abdominal aortic aneurysm (OR, 2.33; 95% CI, 2.30-2.36) increased with each decade of life. Comment: Age is a well-known risk factor for atherosclerosis. The data here, if anything, are likely to underestimate the prevalence of vascular disease. Patients who present for screening studies, the so-called worried well, may be more health oriented and live healthier lifestyles than those who do not. After all, patients known to have vascular disease are not really candidates for "screening" studies and, theoretically, would not be included in the database. It seems they would be unlikely to pay for an examination to confirm what they already know.

Long-term Results of a Randomized Controlled Trial Analyzing the Role of Systematic Pre-operative Coronary Angiography before Elective Carotid Endarterectomy in Patients with Asymptomatic Coronary Artery Disease

“…Overall, this finding underscores the impact of post-operative MI on short-and long-term survival after vascular surgery. 30,31 One concern in this study was that coronary artery angiography might lead to overtreatment of coronary artery lesions and unduly expose asymptomatic patients to complications related to an invasive procedure. In this series, however, no myocardial infarction was observed as a consequence of coronary angiography or revascularization and the mild increase of cardiac biomarkers observed after PCI, without clinical symptoms and/or ECG alterations, has been shown not to be associated with an increased risk of death and MI.…”

Update on Perioperative Myocardial Injury and Infarction

“…Moreover, the greater the increase in troponin, the greater the risk of 30-day mortality with or without symptoms [17,60]. There is also evidence that elevated biomarkers may predict noncardiac-related death [61].…”

“…Application of these guidelines resulted in a reduction in postoperative MI in orthopedic surgical patients [64]. It appears there is a 24-hour period before maximal increase in troponins, and the median time after peak troponin to death from MINS is 9 to 12 days [60,62,65]. Therefore, there is time for medical therapy.…”

Myocardial injury after noncardiac surgery

“…In a prospective cohort study of 2232 elevatedrisk surgery patients aged at least 60 years, van Waes and colleagues [26] also found higher (0.6 mg/l) and lower TnI elevations (0.06-0.59 mg/l) to be associated with higher relative risks (RR) than nonelevated troponin [RR 2.4, (95% CI 1.3-4.2) and RR 4.2 (95% CI 2.1-8.6), respectively].…”

“…PMI, with an incidence of 2-3% and a mortality of 30%, has classically dominated adverse cardiac outcomes after surgery, but appears to be only the tip of the ischemic complications iceberg. PMI is only one manifestation of myocardial ischemia, which in the absence of systematic troponin measurements greatly underestimates the extent of myocardial damage after noncardiac surgery (see chapter detec- 19,25,26].…”