Incidence and risk factors of perioperative myocardial injury after non-cardiac surgery in JAPAN: a prospective observational multicenter cohort study

Abstract Introduction The 2022 European Society of Cardiology guidelines on non-cardiac surgery recommend the measurement of high-sensitivity cardiac troponin T (Hs-cTn T) for perioperative risk assessment in patients who known cardiovascular disease (CVD), cardiovascular (CV) risk factors (including age ≥65 years), or symptoms suggestive of CVD. 1 Perioperative myocardial injury (PMI) was defined as an elevation in cTn, often occurring asymptomatically. However, Japanese patients have lower age-adjusted mortality from CVD than European and North American countries, 2 and the incidence and risk factors of PMI in Japanese patients is not fully elucidated. Purpose This prospective study aimed to examine the incidence and risk factors of PMI in Japanese patients undergoing non-cardiac surgery. Methods We conducted a prospective multicenter cohort study, enrolling adult patients (age ≥18 years) undergoing non-cardiac surgery in Japan. All patients received a systematic screening using NT-proBNP and Hs-cTn T before noncardiac surgery and on postoperative days 1 or 2. PMI was defined as an absolute increase in Hs-cTn T of 14 ng/L from preoperative to postoperative measurements. The primary outcome was the incidence of PMI after non-cardiac surgery, expressed as the number of cases and incidence rate with two-sided 95% confidence intervals (CIs), calculated using the Wilson score method. The secondary outcome was the association between PMI and preoperative factors. A logistic regression analysis was conducted to identify independent risk factors for PMI among 28 perioperative variables, estimating odds ratios (ORs) and 95% CIs. Results From January to September 2024, a total of 1,998 patients undergoing non-cardiac surgery were enrolled. PMI occurred in 48 patients (2.4%; 95% CI, 1.8-3.2). We identified 10 independent perioperative factors associated with PMI that included the following: American society anesthesiology physical status (ASA-PS) ≥3, Revised Cardiac Risk Index ≥3, which including known coronary artery disease; cardiovascular risk factors, cerebrovascular disease; chronic kidney disease, and other cardiovascular risk factor (e.g., age ≥75 yr, hypertension, renal insufficiency (eGFR 60 mL/min/1.73 m2), CVD (e.g., peripheral vascular disease), and anemia. (Table) Conclusion In Japanese patients undergoing non-cardiac surgery, the incidence of PMI was 2.4%, and we identified 10 independent perioperative risk factors for PMI. Our findings suggest that PMI needs to be assessed in patients with these risk factors to optimize perioperative management.Table