Abstract 16362: Early Cardiology Assessment and Intervention Reduces Mortality Following Myocardial Injury After Non-Cardiac Surgery (MINS)

Abstract

Myocardial injury after non-cardiac surgery (MINS) has been recently defined as troponin elevation ≥0.03ng/ml, associated with 3.87 fold increase in early mortality (1). We sought to determine the impact of early cardiology intervention on 30-day mortality in patients who underwent general thoracic surgery and developed MINS. Methods: A retrospective review of patients who underwent thoracic surgery over a 5-year period where troponin levels were routinely measured on the first post-operative day was performed. Data acquisition and mortality status was obtained via medical records and NHS tracing systems. Thirty-day mortality was compared on the MINS cohort using Fisher’s exact square testing and logistic regression analysis. Actuarial survival was calculated using Kaplan Meier method and Cox proportional hazards regression was utilized to determine risk adjusted impact of MINS on post-operative survival. Results: Troponin levels were measured in 492 (96%) of 511 patients and 80 (16%) had troponin elevation fulfilling MINS criteria. Of the MINS positive patients, 61 (76%) received early cardiology consult and a formal diagnosis of “myocardial infarction” stated in 4 (5%). Risk assessment for Acute Myocardial Infarction was performed in all patients and 20 (25%) commenced on anti-platelet agents, 4 (5%) on β-blockers and 1 (1%) underwent primary coronary intervention. In total, 49 (61%) received primary risk factor modification and 26 (33%) had further cardiology outpatient follow-up. There were no significant differences in the proportion who died within the first 30 days in the MINS group (2.6%) compared to the non-MINS group (1.6%; P=0.625). The odds ratio for 30-day mortality in the MINS group was 1.69 (95% CI 0.34 to 8.57, P=0.522). On follow up there were no significant difference on the impact of MINS on survival between the two groups (HR 1.06 95% CI 0.67 to 1.68; P=0.799). Conclusion: Our results confirm MINS is common after general thoracic surgery. We observed that early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in either early or longer term mortality for patients who developed MINS.