Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

Abstract

Background Myocardial injury after non-cardiac surgery is diagnosed following asymptomatic troponin elevation in the perioperative interval. Myocardial injury after non-cardiac surgery is associated with high mortality rates and significant rates of major adverse cardiac events within the first 30 days following surgery. However, less is known regarding its impact on mortality and morbidity beyond this time. This systematic review and meta-analysis aimed to establish the rates of long-term morbidity and mortality associated with myocardial injury after non-cardiac surgery. Methods MEDLINE, Embase and Cochrane CENTRAL were searched, and abstracts screened by two reviewers. Observational studies and control arms of trials, reporting mortality and cardiovascular outcomes beyond 30 days in adult patients diagnosed with myocardial injury after non-cardiac surgery, were included. Risk of bias was assessed using the Quality in Prognostic Studies tool. A random-effects model was used for the meta-analysis of outcome subgroups. Results Searches identified 40 studies. The meta-analysis of 37 cohort studies found a rate of major adverse cardiac events-associated myocardial injury after non-cardiac surgery of 21 per cent and mortality following myocardial injury after non-cardiac surgery was 25 per cent at 1-year follow-up. A non-linear increase in mortality rate was observed up to 1 year after surgery. Major adverse cardiac event rates were also lower in elective surgery compared with a subgroup including emergency cases. The analysis demonstrated a wide variety of accepted myocardial injury after non-cardiac surgery and major adverse cardiac events diagnostic criteria within the included studies. Conclusion A diagnosis of myocardial injury after non-cardiac surgery is associated with high rates of poor cardiovascular outcomes up to 1 year after surgery. Work is needed to standardize diagnostic criteria and reporting of myocardial injury after non-cardiac surgery-related outcomes. Registration This review was prospectively registered with PROSPERO in October 2021 (CRD42021283995).

Predicting perioperative myocardial injury/infarction after noncardiac surgery in patients under surgical and medical co-management: a prospective cohort study

“…Perioperative myocardial injury/infarction (PMI) following noncardiac surgery has been increasingly recognized as a frequent cardiac complication, mostly without typical ischemic symptoms [ 1 – 3 ], which occurs in at least 8% of elective procedures [ 2 , 4 ], and 20% of major surgeries [ 5 ]. Moreover, PMI is independently associated with an increased risk of cardiovascular (CV) morbidity and mortality at 30 days and up to 1 year after noncardiac surgery [ 1 , 6 – 9 ]. Asymptomatic PMI is comparable to symptomatic PMI [ 1 ].…”

Usando Troponina de Alta Sensibilidade para Melhorar a Previsão de Risco após Cirurgia Não Cardíaca – Já Chegamos Lá?

“…Especificamente, foi demonstrado que a liberação de troponina cardíaca (cTn) na corrente sanguínea, refletindo lesão multifatorial de cardiomiócitos, sinaliza aumento de morbidade e mortalidade quando elevada no período perioperatório. 6 No entanto, e até agora, a integração deste chamado MINS ("lesão miocárdica após cirurgia não cardíaca") com a mais familiar avaliação de risco clínico, na tarefa de previsão de risco continua a ser uma questão a ser devidamente respondida.…”

“…Specifically, the bloodstream release of cardiac troponin (cTn), reflecting multifactorial cardiomyocyte injury, has been shown to signal increased morbidity and mortality when elevated in the perioperative period. 6 However, and until now, the integration of this so-called MINS ("myocardial injury after non-cardiac surgery") with the more familiar clinical risk evaluation in the task of risk prediction remains a question to be properly answered.…”