Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study
Por:
Álvarez-Garcia J., Popova E., Vives-Borrás M., de Nadal M., Ordonez-Llanos J., Rivas-Lasarte M., Moustafa A.-H., Solé-González E., Paniagua-Iglesias P., Garcia-Moll X., Viladés-Medel D., Leta-Petracca R., Oristrell G., Zamora J., Ferreira-González I., Alonso-Coello P., Carreras-Costa F.
Publicada:
10 feb 2023
Ahead of Print:
10 feb 2023
Resumen:
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). © 2023, The Author(s).
Filiaciones:
Álvarez-Garcia J.:
Department of Cardiology, Hospital Universitario Ramon y Cajal, M-607, 9,100, Madrid, 28034, Spain
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain
Popova E.:
IIB SANT PAU, Institut d’Investigació Biomèdica Sant Pau, Sant Quintí 77, Barcelona, 08041, Spain
Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, 167, Barcelona, 08025, Spain
Vives-Borrás M.:
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), Department of Cardiology, Carretera de Valldemossa, 79, Balearic Islands, Palma, 07120, Spain
Department of Cardiology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, Illes Balears, Palma, Spain
de Nadal M.:
Department of Anaesthesiology and Intensive Care, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron, 119, Barcelona, 08035, Spain
Ordonez-Llanos J.:
Department of Biochemistry, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Foundation for Clinical Biochemistry & Molecular Pathology, Barcelona, Spain
Rivas-Lasarte M.:
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, C. Joaquín Rodrigo, 1, Majadahonda, Madrid, 28222, Spain
Moustafa A.-H.:
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Solé-González E.:
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Department of Cardiology, Hospital Clinic i Provincial, C. de Villarroel, 170, Barcelona, 08036, Spain
Paniagua-Iglesias P.:
Department of Anaesthesia and Pain Management, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Garcia-Moll X.:
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Viladés-Medel D.:
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Leta-Petracca R.:
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Oristrell G.:
Department of Cardiology, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron, 119, Barcelona, 08035, Spain
Zamora J.:
Clinical Biostatistics Unit, IRYCIS, Hospital Universitario Ramon y Cajal, M-607, 9,100, Madrid, 28034, Spain
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Ferreira-González I.:
Department of Cardiology, Hospital Universitari Vall d’Hebron, Passeig de la Vall d’Hebron, 119, Barcelona, 08035, Spain
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Alonso-Coello P.:
IIB SANT PAU, Institut d’Investigació Biomèdica Sant Pau, Sant Quintí 77, Barcelona, 08041, Spain
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Carreras-Costa F.:
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, Barcelona, 08026, Spain
Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain
gold, Green Published, Gold
|