Key result
Myocardial injury after non-cardiac surgery (MINS) was associated with a 15.4% incidence of 1-year major cardiovascular events and ischemic MRI findings, despite a similar prevalence of significant coronary artery disease compared to controls (30% vs 33%).
Why the study?
Myocardial injury after non-cardiac surgery (MINS) is a frequent, often subclinical complication associated with increased morbidity and mortality, necessitating diagnosis and investigation of its causes for potential prevention.
Does advanced cardiac imaging reveal differences in coronary artery disease prevalence and 1-year MACE between patients with and without MINS after major non-cardiac surgery?
Observational (n=64)
Yes
Does advanced cardiac imaging reveal differences in coronary artery disease prevalence and 1-year MACE between patients with and without MINS after major non-cardiac surgery?
Advanced cardiac imaging reveals that while subclinical CAD is equally prevalent in patients with and without MINS, ischemic patterns on MRI and 1-year MACE are exclusively observed in those with MINS.
BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention. METHODS: Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48-72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality. RESULTS: We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%). CONCLUSION: This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, obtained in a pilot study, suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes. Trial registration Clinicaltrials.gov identifier: NCT03438448 (19/02/2018).
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Álvarez‐García et al. (2023) conducted an observational in Myocardial injury after major non-cardiac surgery (MINS) (n=64). Myocardial injury after non-cardiac surgery (MINS) vs. No MINS (controls) was evaluated on Prevalence of significant coronary artery disease (CAD-RADS ≥ 3). Myocardial injury after non-cardiac surgery (MINS) was associated with a 15.4% incidence of 1-year major cardiovascular events and ischemic MRI findings, despite a similar prevalence of significant coronary artery disease compared to controls (30% vs 33%).
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