Perioperative myocardial injury after elective neurosurgery: incidence, risk factors, and effects on mortality

Abstract

BackgroundPerioperative myocardial injury is an important reason of mortality and morbidity after neurosurgery. It usually is missed due to asymptomatic character. In the present study, we investigated myocardial injury after noncardiac surgery (MINS) incidence, the risk factor for MINS and association of MINS with 30-day mortality in neurosurgery patients. MethodsPatients with cardiac risk who underwent elective neurosurgery were enrolled to the study. The patients' demographics, comorbidities, medications used, medical history, and type of operation were recorded.The high-sensitivity cardiac troponin (hs-cTn) levels of the patients were measured 12, 24, and 48 hours after surgery. The patients were considered as MINS-positive if at least one of their postoperative hs-cTn measurement values was ≥14 ng/l. All the patients were followed up for 30 days after surgery for evaluation of their outcomes, including total mortality, mortality due to cardiovascular cause, and major cardiac events. ResultsTotal 312 patients completed the study and 64 (20.5%) of them was MINS positive. Long antiplatelet or anticoagulant drug cessation time (OR: 4.9, 95%CI: 2.1-9.4) was found the most prominent risk factor for MINS occurrence. Total mortality rate was 2.4% and 6.2% in patients MINS negative and positive respectively (p = 0.112). The mortality rate due to cardiovascular reasons (0.8% for without MINS, 4.7for with MINS, and p=0.026) and incidence of the major cardiac event (4% for without MINS, 10.9 for with MINS, and p=0.026) were signi cantly higher in patients with MINS. ConclusionsMINS is a common problem after neurosurgery and, high postoperative hs-cTn level is associated with mortality and morbidity.

Emergent Coronary Thrombectomy for Acute Myocardial Infarction Immediately Following Craniotomy with Tumor Resection

“…The risk of perioperative cardiac events is more significant for patients undergoing neurosurgical procedures who have chronic antiplatelet and antithrombotic therapy interrupted perioperatively [ 2 ]. Utilizing postoperative high-sensitivity troponin levels, a prospective cohort study identified perioperative myocardial injury in 20.5% of patients undergoing elective neurosurgery [ 3 ]. Patients undergoing oncologic surgery may face even greater perioperative risks, with one population-based study identifying a more than twofold increase in the incidence of arterial thromboembolism and myocardial infarction in the first 6 months following a new diagnosis of cancer [ 4 ].…”