Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study

Autor: Jesús Álvarez-Garcia, Ekaterine Popova, Miquel Vives-Borrás, Miriam de Nadal, Jordi Ordonez-Llanos, Mercedes Rivas-Lasarte, Abdel-Hakim Moustafa, Eduard Solé-González, Pilar Paniagua-Iglesias, Xavier Garcia-Moll, David Viladés-Medel, Rubén Leta-Petracca, Gerard Oristrell, Javier Zamora, Ignacio Ferreira-González, Pablo Alonso-Coello, Francesc Carreras-Costa
Přispěvatelé: Institut Català de la Salut, [Álvarez-Garcia J] Department of Cardiology, Hospital Universitario Ramon y Cajal, Madrid, Spain. Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain. [Popova E] IIB SANT PAU, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain. Centro Cochrane Iberoamericano, Barcelona, Spain. Centro Cochrane Iberoamericano, Barcelona, Spain. [Vives-Borrás M] Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), Department of Cardiology, Palma, Balearic Islands, Spain. Department of Cardiology, Hospital Universitari Son Espases, Palma, Illes Balears, Spain. [de Nadal M] Servei d’Anestesiologia, Reanimació i Tractament del Dolor i Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Ordonez-Llanos J] Department of Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Foundation for Clinical Biochemistry & Molecular Pathology, Barcelona, Spain. [Rivas-Lasarte M] Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain. [Oristrell G] Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Ferreira-González I] Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain, Vall d'Hebron Barcelona Hospital Campus
Rok vydání: 2023
Předmět:
Cirurgia - Complicacions
heridas y lesiones::traumatismos torácicos::lesiones cardíacas [ENFERMEDADES]
Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Image Interpretation
Computer-Assisted::Tomography
X-Ray Computed::Computed Tomography Angiography [ANALYTICAL
DIAGNOSTIC AND THERAPEUTIC TECHNIQUES
AND EQUIPMENT]
Cor - Vàlvules - Ferides i lesions
diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::interpretación de imágenes asistida por ordenador::tomografía computarizada por rayos X::angiografía por tomografía computarizada [TÉCNICAS Y EQUIPOS ANALÍTICOS
DIAGNÓSTICOS Y TERAPÉUTICOS]
Angiografia
Pathological Conditions
Signs and Symptoms::Pathologic Processes::Postoperative Complications [DISEASES]
Wounds and Injuries::Thoracic Injuries::Heart Injuries [DISEASES]
Cor - Imatgeria
Cardiology and Cardiovascular Medicine
afecciones patológicas
signos y síntomas::procesos patológicos::complicaciones posoperatorias [ENFERMEDADES]
Zdroj: Scientia
ISSN: 1471-2261
Popis: 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).
Databáze: OpenAIRE
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