Key result
Postoperative acute myocardial injury affects ~20% of noncardiac patients, linked to baseline comorbidities and beta-blockers.
Why the study?
Postoperative myocardial injury after noncardiac surgery is common and linked to morbidity and mortality, but the incidence and risk factors of postoperative acute myocardial injury were unknown due to inconsistent definitions.
Meta-Analysis (n=11,494)
Approximately 1 in 5 noncardiac surgery patients develop postoperative acute myocardial injury, which is strongly associated with baseline comorbidities such as heart failure, hypertension, and renal impairment.
Supports preoperative risk stratification for noncardiac surgery; leaves open whether modifying identified factors reduces injury.
INTRODUCTION: Postoperative myocardial injury after noncardiac surgery is common and is associated with short- and long-term morbidity and mortality. However, the incidence and risk factors for postoperative acute myocardial injury (POAMI) are currently unknown due to inconsistent definitions. METHODS: We systematically searched PubMed and Web of Science to identify studies that applied the change value of preoperative and postoperative cardiac troponins to define cardiac injury. We estimated the pooled incidence, risk factors, and 30-day and long-term mortality of POAMI in noncardiac patients. The study protocol was registered with PROSPERO, CRD42023401607. RESULTS: Ten cohorts containing 11,494 patients were included for analysis. The pooled incidence of POAMI was 20% (95% CI: 16% to 23%). Preoperative hypertension (OR: 1.47; 95% CI: 1.30 to 1.66), cardiac failure (OR: 2.63; 95% CI: 2.01 to 3.44), renal impairment (OR: 1.66; 95% CI: 1.48 to 1.86), diabetes (OR: 1.43; 95% CI: 1.27 to 1.61), and preoperative beta-blocker intake (OR: 1.65; 95% CI: 1.10 to 2.49) were the risk factors for POAMI. Age (mean difference: 2.08 years; 95% CI: -0.47 to 4.62), sex (male, OR: 1.16; 95% CI: 0.77 to 1.76), body mass index (mean difference: 0.35; 95% CI: -0.86 to 1.57), preoperative coronary artery disease (OR: 2.10; 95% CI: 0.85 to 5.21), stroke (OR: 0.90; 95% CI: 0.50 to 1.59) and preoperative statins intake (OR: 0.65; 95% CI: 0.21 to 2.02) were not associated with POAMI. Patients with POAMI had higher preoperative hsTnT levels (mean difference: 5.92 ng/L; 95% CI: 4.17 to 7.67) and lower preoperative hemoglobin levels (mean difference: -1.29 g/dL; 95% CI: -1.43 to -1.15) than patients without. CONCLUSION: Based on this meta-analysis, approximately 1 in 5 of noncardiac patients develop POAMI. However, the lack of a universally recognized definition for POAMI, which incorporates diverse cardiac biomarkers and patient groups, poses a challenge in accurately characterizing its incidence, risk factors, and clinical outcomes.
No takes yet. Share an insight, caveat, or question.
Chang et al. (2023) conducted a meta-analysis in Postoperative acute myocardial injury (POAMI) (n=11,494). Noncardiac surgery was evaluated on Pooled incidence of postoperative acute myocardial injury (POAMI) (95% CI 16% to 23%). The pooled incidence of postoperative acute myocardial injury in noncardiac patients was 20%, with preoperative hypertension, cardiac failure, renal impairment, diabetes, and beta-blocker intake identified as significant risk factors.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: