Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study

Jesús Álvarez-Garcia, Ekaterine Popova*, Miquel Vives-Borrás, Miriam de Nadal*, Jordi Ordonez-Llanos, Mercedes Rivas-Lasarte, Abdel Hakim Moustafa, Eduard Solé-González, Pilar Paniagua-Iglesias, Xavier Garcia-Moll, David Viladés-Medel, Rubén Leta-Petracca, Gerard Oristrell, Javier Zamora, Ignacio Ferreira-González, Pablo Alonso-Coello, Francesc Carreras-Costa

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention.

Methods: Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48–72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality.

Results: We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%).

Conclusion: This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, obtained in a pilot study, suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes.

Trial registration Clinicaltrials.gov identifier: NCT03438448 (19/02/2018).

Original languageEnglish
Article number78
Number of pages10
JournalBMC Cardiovascular Disorders
Volume23
Issue number1
DOIs
Publication statusPublished - 10 Feb 2023

Bibliographical note

Funding Information:
The study has been supported by research grant from the Instituto de Salud Carlos III, Spain (PI16/01162), partly funded by Fondo Europeo de Desarrollo Regional (FEDER), Unión Europea, “Una manera de hacer Europa” to Ekaterine Popova, by Generalitat de Catalunya (PERIS SLT017/20/000089) to Ekaterine Popova and by a "Marato de TV3" grant (20150110) to Pablo Alonso-Coello.

Publisher Copyright:
© 2023, The Author(s).

Keywords

  • Cardiac imaging
  • Myocardial injury
  • Noncardiac surgery
  • Pathophysiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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