Active surveillance detected perioperative myocardial infarction/injury in 13.3% of high-risk noncardiac surgery patients, up to 29% in those with severe renal dysfunction.
Active surveillance for perioperative myocardial infarction/injury in high-risk patients undergoing noncardiac surgery yields an incidence of >10% in most subgroups, supporting current guideline recommendations for screening.
Absolute Event Rate: 0% vs 0%
Abstract Background Current clinical practice guidelines recommend active surveillance for perioperative myocardial infarction/injury (PMI) following major noncardiac surgery. However, patient, and procedural characteristics that determine its yield and, thereby cost-effectiveness are incompletely understood. Objective We aimed to characterize the incidence of PMI in high-risk patients undergoing noncardiac surgery. Design: Prospective multicentre diagnostic study centrally adjudicating the incidence of PMI. We included patients aged =45 years scheduled to undergo inpatient surgery considered to be at elevated cardiovascular risk, which was defined as either group 1) known atherosclerotic cardiovascular disease (ASCVD) OR group 2) aged =65 years without any known ASCVD. We aimed to find groups with especially high and low risk of PMI to optimise screening inclusion criteria. Therefore univariable incidence rates of PMI were calculated stratified by group for different patient characteristics and surgical specialties. Results Among 9290 individual patients included, 1239 (13.3%) experienced PMI. Among patient characteristics, particularly high rates of PMI were associated with chronic heart failure (27% in group 1 with ASCVD, 19% in group 2 without ASCVD), severe renal dysfunction (29% and 19%), valvular heart disease (27% and 16%), atrial fibrillation (24% and 16%), anemia (24% and 17%), and age above 80 years (24% and 15%) in both groups, respectively. In contrast, despite known ASCVD, the incidence of PMI in group 1 was only 7% in patients aged 45-54 years and 11% in patients aged 55-64 year (Figure). Among surgical specialties, the incidence of PMI was highest in thoracic surgery (30% and 21%, respectively), with no surgical speciality showing especially low incidence of PMI in these patient groups. Conclusions Following current guideline recommendation, PMI rates are 10% in the majority of patients subgroups. Varying PMI incidence across patient characteristics and surgical specialties may guide physicians and institutions in estimating the incidence of PMI within an active surveillance program, thereby determining institutional patient selection criteria.PMI Incidence Rates
Puelacher et al. (Sat,) reported a other. Active surveillance detected perioperative myocardial infarction/injury in 13.3% of high-risk noncardiac surgery patients, up to 29% in those with severe renal dysfunction.