Key result
The EACTS algorithm diagnosed perioperative myocardial infarction in 2.5% of patients versus 2.6% with the 4UD, and substantially reduced myocardial injury diagnoses (29.9% vs 87.2%).
Why the study?
The clinical applicability and relevance of the European Association for Cardio-thoracic Surgery algorithm for diagnosing perioperative myocardial injury and myocardial infarction compared with the Fourth Universal Definition required evaluation.
Does the EACTS algorithm compared to the 4UD change the incidence of diagnosed perioperative myocardial injury and infarction in adults undergoing cardiac surgery?
Cohort (n=1,142)
Yes
Does the EACTS algorithm compared to the 4UD change the incidence of diagnosed perioperative myocardial injury and infarction in adults undergoing cardiac surgery?
The EACTS algorithm substantially reduces the incidence of diagnosed perioperative myocardial injury compared to the 4UD while maintaining a strong association with 1-year mortality.
May limit myocardial injury overdiagnosis after cardiac surgery; leaves open adoption pending randomized validation.
OBJECTIVE: This study evaluated the clinical applicability and relevance of the European Association for Cardio-thoracic Surgery (EACTS) algorithm for the diagnosis of perioperative myocardial injury and myocardial infarction (PMI) after cardiac surgery, compared to the Fourth Universal Definition of Myocardial Infarction (4UD). DESIGN: This was a prospective two-centre cohort study in adults undergoing a range of elective and urgent cardiac surgeries. PMI and myocardial injury were diagnosed using both the EACTS algorithm and the 4UD. Primary outcome was to compare PMI and myocardial injury incidences between definitions. One-year mortality hazard ratios (HRs) adjusted for EuroSCORE II were calculated for perioperative biomarker elevation, myocardial injury, and PMI versus no myocardial injury. RESULTS: In total, 1142 patients were included. Most common procedures were coronary artery bypass grafting (53.0%) and isolated valve surgery (24.4%). The EACTS algorithm diagnosed 2.5% (n = 28) of patients as PMI (vs 2.6%, n = 30 with 4UD), 29.9% (n = 341) as myocardial injury (vs 87.2%, n = 996 with 4UD), 37.6% (n = 429) as perioperative biomarker elevation, and 30.1% (n = 344) as no myocardial injury (vs 10.2%, n = 116 with 4UD). Adjusted HRs for 1-year mortality with the EACTS algorithm were 12.3 (95% CI, 2.0-74.7) for PMI (vs 13.7 [95% CI, 1.5-124.6] with 4UD), 3.6 (95% CI, 0.8-16.6) for myocardial injury (vs 2.3 [95% CI, 0.3-17.0] with 4UD), and 2.7 (95% CI, 0.6-12.6) for perioperative biomarker elevation. CONCLUSIONS: Implementation of the EACTS algorithm led to a similar incidence of PMI but substantially reduced myocardial injury incidence compared to the 4UD while maintaining its clinically relevant association with mortality.
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Thio et al. (2025) conducted a cohort in Perioperative myocardial injury and infarction after cardiac surgery (n=1,142). EACTS algorithm vs. Fourth Universal Definition of Myocardial Infarction (4UD) was evaluated on Incidence of perioperative myocardial infarction (PMI). The EACTS algorithm diagnosed perioperative myocardial infarction in 2.5% of patients versus 2.6% with the 4UD, and substantially reduced myocardial injury diagnoses (29.9% vs 87.2%).
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