The Relevance of Implementing the Systematic Screening of Perioperative Myocardial Injury in Noncardiac Surgery Patients

Ekaterine Popova, Pilar Paniagua-Iglesias, Jesús Álvarez-García, Miquel Vives-Borrás, Aránzazu González-Osuna, Álvaro García-Osuna, Mercedes Rivas-Lasarte, Gisela Hermenegildo-Chavez, Ruben Diaz-Jover, Gonzalo Azparren-Cabezon, Montserrat Barceló-Trias, Abdel Hakim Moustafa, Raul Aguilar-Lopez, Jordi Ordonez-Llanos, Pablo Alonso-Coello

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Perioperative myocardial injury (PMI) is a common cardiac complication. Recent guidelines recommend its systematic screening using high-sensitivity cardiac troponin (hs-cTn). However, there is limited evidence of local screening programs. We conducted a prospective, single-center study aimed at assessing the feasibility and outcomes of implementing systematic PMI screening. Hs-cTn concentrations were measured before and after surgery. PMI was defined as a postoperative hs-cTnT of ≥14 ng/L, exceeding the preoperative value by 50%. All patients were followed-up during the hospitalization, at one month and one year after surgery. The primary outcome was the incidence of death and major cardiovascular and cerebrovascular events (MACCE). The secondary outcomes focused on the individual components of MACCE. We included two-thirds of all eligible high-risk patients and achieved almost complete compliance with follow-ups. The prevalence of PMI was 15.7%, suggesting a higher presence of cardiovascular (CV) antecedents, increased perioperative CV complications, and higher preoperative hs-cTnT values. The all-cause death rate was 1.7% in the first month, increasing up to 11.2% at one year. The incidence of MACCE was 9.5% and 8.6% at the same time points. Given the observed elevated frequencies of PMI and MACCE, implementing systematic PMI screening is recommendable, particularly in patients with increased cardiovascular risk. However, it is important to acknowledge that achieving optimal screening implementation comes with various challenges and complexities.

Original languageEnglish
Article number5371
JournalJournal of Clinical Medicine
Volume12
Issue number16
DOIs
StatePublished - Aug 2023
Externally publishedYes

Keywords

  • high sensitivity cardiac troponin T
  • noncardiac surgery
  • perioperative myocardial injury
  • screening

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