Key result
Preoperative myocardial injury significantly increased 30-day mortality after non-cardiac surgery compared to normal troponin levels (HR 3.12), to a similar degree as postoperative myocardial injury.
Why the study?
Although both pre- and postoperative myocardial injuries are associated with increased postoperative mortality, no study had directly compared their effects on 30-day mortality after non-cardiac surgery.
Does preoperative myocardial injury increase 30-day mortality to a similar degree as postoperative myocardial injury in patients undergoing non-cardiac surgery?
Cohort (n=4,632)
No
Does preoperative myocardial injury increase 30-day mortality to a similar degree as postoperative myocardial injury in patients undergoing non-cardiac surgery?
Hazard Ratio: 3.12 (95% CI 1.62–6.01)
Absolute Event Rate: 10.7% vs 1.4%
p-value: p=0.001
Preoperative myocardial injury is associated with a similar increase in 30-day mortality as postoperative myocardial injury following non-cardiac surgery.
Preoperative myocardial injury signals elevated perioperative mortality risk similar to postoperative injury; extends focus on troponin monitoring but remains hypothesis-generating.
Although both pre- and postoperative myocardial injuries are strongly associated with an increased postoperative mortality, no study has directly compared the effects of pre- and postoperative myocardial injuries on 30-day mortality after non-cardiac surgery. Therefore, we evaluated and compared the effects of pre- and postoperative myocardial injury on 30-day mortality after non-cardiac surgery. From January 2010 to December 2016, patients undergoing non-cardiac surgery were stratified into either the normal (n = 3182), preoperative myocardial injury (n = 694), or postoperative myocardial injury (n = 756) groups according to the peak cardiac troponin value. Myocardial injury was defined as a sole elevation of cardiac troponin value above the 99th percentile upper reference limit without ischemic symptom using the 4th universal definition of myocardial infarction. Patients in the preoperative myocardial injury group were further divided into the attenuated (n = 177) or persistent myocardial injury group (n = 517) according to the normalization of cardiac troponin level in postoperative period. As the primary outcome, postoperative 30-day mortalities were compared among the groups using the weighted Cox proportional-hazards regression models with the inverse probability weighting. Compared with the normal group, postoperative 30-day mortality was increased significantly both in the pre- and postoperative myocardial injury groups (1.4% vs. 10.7%; hazard ratio [HR] 3.12; 95% confidence interval [CI] 1.62-6.01; p = 0.001 and 1.4% vs. 7.4%; HR 4.49; 95% CI 2.34-8.60; p < 0.001, respectively), however, there was no difference between the pre- and postoperative myocardial injury groups (HR, 1.44; 95% CI 0.79-2.64; p = 0.45). In addition, the attenuated myocardial injury group showed a significantly lower postoperative 30-day mortality than the persistent myocardial injury group (5.6% vs. 12.4%; HR 2.23; 95% CI 1.17-4.44; p = 0.02). In patients undergoing non-cardiac surgery, preoperative myocardial injury also increased postoperative 30-day mortality to a similar degree of postoperative myocardial injury. Further studies on the importance of preoperative myocardial injury are needed.Clinical trial number and registry URL: KCT0004348 ( www.cris.nih.go.kr ).
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Lee et al. (2020) conducted a cohort in Non-cardiac surgery (n=4,632). Preoperative myocardial injury vs. Normal (no myocardial injury) was evaluated on 30-day mortality (HR 3.12, 95% CI 1.62-6.01, p=0.001). Preoperative myocardial injury significantly increased 30-day mortality after non-cardiac surgery compared to normal troponin levels (HR 3.12), to a similar degree as postoperative myocardial injury.
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