Myocardial injury after non-cardiac surgery (MINS) is a frequent, but often subclinical, complication that is associated with increased morbidity and mortality. As such, there is a need to improve diagnoses and prevention.
Researchers performed an observational study aiming to detect cases of MINS, its associations with silent coronary artery disease (CAD), and its impact on long-term adverse outcomes in patients undergoing major non-cardiac surgery without signals of myocardial ischemia in the postoperative period.
In the trial record, published in BMC Cardiovascular Disorders, the researchers reported that advanced imaging methods showed a similar incidence of CAD in MINS and control patients; however, the presence of cardiac ischemic findings on magnetic resonance imaging (MRI) and worse prognosis were only observed in patients with MINS.
Cardiac Ischemia More Frequent With Myocardial Injury After Non-Cardiac Surgery
The study defined MINS as a high-sensitive cardiac troponin T (hs-cTnT) concentration above 14 ng/L between 48 and 72 hours after surgery, and exceeding the preoperative value by 50%. Controls were patients who underwent major non-cardiac surgery without developing MINS.
The primary imaging methods included cardiac computed tomography angiography (CCTA) and MRI within 1 month of discharge, and the primary end points were prevalence of CAD between MINS and controls and incidence of major cardiovascular events (MACE) 1 year after surgery. Significant CAD was defined as CADS-RADS category ≥3.
A total of 52 patients with MINS and 12 controls were enrolled. Authors attributed the small sample size to the complexity of the study design as well as the COVID-19 pandemic waves interfering with later follow-ups. Researchers observed significant CAD on CCTA in 20 (30%) patients in the MINS group and 20 (33%) controls).
Comparatively, ischemic patterns (n=5) and ischemic segments (n=2) identified by cardiac MRI were only witnessed among patients in the MINS group. Likewise, MACE events within 1-year were also only reported in patients with MINS, at a rate of 15.4%.
Ultimately, the authors suggested their pilot data findings “suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes.”
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