Cardiovascular Imaging Following Perioperative Myocardial Infarction/Injury

Background : Patients developing perioperative myocardial infarction/injury(PMI) have high mortality. PMI work-up and therapy remain poorly defined. Methods : In a prospective multicenter study enrolling high-risk patients undergoing major non-cardiac surgery within a systematic PMI screening and clinical response program, the frequency of cardiovascular imaging during PMI work-up and its yield for possible type 1 myocardial infarction(T1MI) was assessed. Automated PMI detection triggered evaluation by the treating physician/ cardiologist on service, who determined selection/timing of cardiovascular imaging. In transthoracic echocardiography(TTE) a new wall motion abnormality within 30days, in myocardial perfusion imaging(MPI) a new scar or ischemia within 90days, and in coronary angiography(CA) Ambrose-Type II or complex lesions within 7days of PMI detection were considered indicative of T1MI. Results : In patients with PMI, 21%(268/1269) underwent at least one cardiac imaging modality. TTE was used in 13%(163/1269), MPI in 3%(37/1269), and CA in 5%(68/1269). Consultation by a cardiologist, was associated with higher use of cardiaovascular imaging(27% versus 13%). Signs indicative of T1MI were found in 8% of TTE, 46% of MPI, and in 63% of CA. Conclusion: Most patients with PMI did not receive any cardiovascular imaging within their PMI work-up. If performed, MPI and CA have high yield for signs indicative of T1MI. Study registration: https://clinicaltrials.gov/ct2/show/NCT02573532