Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study
Copyright policy )Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study
Abstract 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).
adverse outcome, Myocardial Ischemia, clinical outcome, Pilot Projects, Coronary Artery Disease, anticoagulant agent, hydroxymethylglutaryl coenzyme A reductase inhibitor, surgery, study design, Postoperative Complications, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Image Interpretation, Computer-Assisted::Tomography, X-Ray Computed::Computed Tomography Angiography, cardiovascular disease, Risk Factors, dipeptidyl carboxypeptidase inhibitor, postoperative complication, DISEASES::Wounds and Injuries::Thoracic Injuries::Heart Injuries, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::interpretación de imágenes asistida por ordenador::tomografía computarizada por rayos X::angiografía por tomografía computarizada, Prospective Studies, Cor - Imatgeria, pathophysiology, Factores de Riesgo, troponin T, adult, coronary artery disease reporting and data system, pilot study, beta adrenergic receptor blocking agent, Estudios Prospectivos, ivabradine, Isquemia Miocárdica, Humanos, myocardial injury after non-cardiac surgery, female, Proyectos Piloto, Myocardial injury, coronary artery disea, coronary artery disease, prospective study, heart muscle ischemia, hypertension, Cirurgia - Complicacions, advanced cardiac imaging, Cor - Vàlvules - Ferides i lesions, complication, electrocardiogram, Enfermedad de la Arteria Coronaria, Pathophysiology, Article, cardiac imaging, cardiovascular magnetic resonance, male, surgical patient, ENFERMEDADES::heridas y lesiones::traumatismos torácicos::lesiones cardíacas, DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications, Diseases of the circulatory (Cardiovascular) system, follow up, Humans, controlled study, human, Angiografia, preoperative period, Lesiones Cardíacas, computed tomographic angiography, Research, disease association, dyslipidemia, heart muscle injury, Noncardiac surgery, COVID-19, acetylsalicylic acid, thromboembolism, major clinical study, mortality, atenolol, ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::complicaciones posoperatorias, Complicaciones Posoperatorias, hospital discharge, Heart Injuries, RC666-701, protein blood level, incidence, observational study, coronary angiography, Cardiac imaging
adverse outcome, Myocardial Ischemia, clinical outcome, Pilot Projects, Coronary Artery Disease, anticoagulant agent, hydroxymethylglutaryl coenzyme A reductase inhibitor, surgery, study design, Postoperative Complications, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Image Interpretation, Computer-Assisted::Tomography, X-Ray Computed::Computed Tomography Angiography, cardiovascular disease, Risk Factors, dipeptidyl carboxypeptidase inhibitor, postoperative complication, DISEASES::Wounds and Injuries::Thoracic Injuries::Heart Injuries, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::interpretación de imágenes asistida por ordenador::tomografía computarizada por rayos X::angiografía por tomografía computarizada, Prospective Studies, Cor - Imatgeria, pathophysiology, Factores de Riesgo, troponin T, adult, coronary artery disease reporting and data system, pilot study, beta adrenergic receptor blocking agent, Estudios Prospectivos, ivabradine, Isquemia Miocárdica, Humanos, myocardial injury after non-cardiac surgery, female, Proyectos Piloto, Myocardial injury, coronary artery disea, coronary artery disease, prospective study, heart muscle ischemia, hypertension, Cirurgia - Complicacions, advanced cardiac imaging, Cor - Vàlvules - Ferides i lesions, complication, electrocardiogram, Enfermedad de la Arteria Coronaria, Pathophysiology, Article, cardiac imaging, cardiovascular magnetic resonance, male, surgical patient, ENFERMEDADES::heridas y lesiones::traumatismos torácicos::lesiones cardíacas, DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications, Diseases of the circulatory (Cardiovascular) system, follow up, Humans, controlled study, human, Angiografia, preoperative period, Lesiones Cardíacas, computed tomographic angiography, Research, disease association, dyslipidemia, heart muscle injury, Noncardiac surgery, COVID-19, acetylsalicylic acid, thromboembolism, major clinical study, mortality, atenolol, ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::complicaciones posoperatorias, Complicaciones Posoperatorias, hospital discharge, Heart Injuries, RC666-701, protein blood level, incidence, observational study, coronary angiography, Cardiac imaging
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