Exploring criteria for active surveillance of perioperative myocardial infarction/injury following noncardiac surgery

Abstract

Abstract Introduction Recent cardiology guidelines on perioperative management of cardiovascular diseases during noncardiac surgery include recommendations concerning perioperative screening for perioperative myocardial infarction/injury (PMI) to improve patient care. However, little evidence exists on the optimal population to be screened. Methods In this post-hoc analysis of our ongoing prospective multicenter observational study BASEL-PMI which included consecutive high-risk patients undergoing major noncardiac surgery, who 1) were ≥45 years with a history of coronary artery disease, peripheral arterial disease, or stroke/TIA, summarized as established atherosclerotic disease (EAD) OR 2) were ≥65 years old. For these two groups, we calculated univariable incidences of PMI stratified by risk factors, surgical specialties, and surgical risk estimates . A Conway-Maxwell Poisson regression model was used to obtain multivariable adjusted incidence rates. Results Between 2014-2018 9290 patients were included, of which 13.3% developed a PMI. The incidence rates of PMI were higher in patients with EAD than in patients without EAD, but in both groups the incidence of PMI was >10%. In both groups, patients with chronic heart failure (CHF, 19 and 27%, respectively) and chronic kidney disease < 30 ml/min (19 and 29%, respectively) were associated with the highest incidences of PMI. In multivariable analysis, high surgical risk classification, anemia, and a metabolic equivalent of task (MET) <4 showed the highest incidence rate of PMI (high-risk surgery: 8.08/100 patients, intermediate-risk surgery 7.63/100 patients, anemia: 6.73/100 patients, MET <4: 6.25/100 patients), while cardiovascular comorbidities were evenly distributed. Conclusions Patients undergoing noncardiac surgery with established EAD or aged >65 years all show an incidence of PMI >10%, hence screening seems warranted in those patients. Established atherosclerotic disease, established CHF, higher risk of surgery, anaemia, and poor MET are associated with high rates of PMI.Poisson adjusted PMI Incidence Rate