Evaluating Myocardial Injury After Non-Cardiac Surgery on Imaging

Myocardial injury after non-cardiac surgery (MINS) is a frequent, but often subclinical, complication that is associated with increased morbidity and mortality.  As such, there is a need to improve diagnoses and prevention.

Researchers performed an observational study aiming to detect cases of MINS, its associations with silent coronary artery disease (CAD), and its impact on long-term adverse outcomes in patients undergoing major non-cardiac surgery without signals of myocardial ischemia in the postoperative period.

In the trial record, published in BMC Cardiovascular Disorders, the researchers reported that advanced imaging methods showed a similar incidence of CAD in MINS and control patients; however, the presence of cardiac ischemic findings on magnetic resonance imaging (MRI) and worse prognosis were only observed in patients with MINS.

Cardiac Ischemia More Frequent With Myocardial Injury After Non-Cardiac Surgery

The study defined MINS as a high-sensitive cardiac troponin T (hs-cTnT)  concentration above 14 ng/L between 48 and 72 hours after surgery, and exceeding the preoperative value by 50%. Controls were patients who underwent major non-cardiac surgery without developing MINS.

The primary imaging methods included cardiac computed tomography angiography (CCTA) and MRI within 1 month of discharge, and the primary end points were prevalence of CAD between MINS and controls and incidence of major cardiovascular events (MACE) 1 year after surgery. Significant CAD was defined as CADS-RADS category ≥3.

A total of 52 patients with MINS and 12 controls were enrolled. Authors attributed the small sample size to the complexity of the study design as well as the COVID-19 pandemic waves interfering with later follow-ups. Researchers observed significant CAD on CCTA in 20 (30%) patients in the MINS group and 20 (33%) controls).

Comparatively, ischemic patterns (n=5) and ischemic segments (n=2) identified by cardiac MRI were only witnessed among patients in the MINS group. Likewise, MACE events within 1-year were also only reported in patients with MINS, at a rate of 15.4%.

Ultimately, the authors suggested their pilot data findings “suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes.”

Read More Studies on Coronary and Peripheral Artery Disease