Article Impact Level: HIGH Data Quality: STRONG Summary of the European Heart Journal, ehac798. https://doi.org/10.1093/eurheartj/ehac798 Dr. Christian Puelacher et al
Points
- Perioperative myocardial infarction or injury is a common heart problem after non-cardiac surgical treatment. There is an immediate requirement for a deeper knowledge of the root causes and consequences.
- Perioperative myocardial infarction is a critical factor in postoperative fatality and a common perioperative cardiovascular consequence after a significant non-cardiac operation.
- 1–5 most preoperative myocardial infarctions do not exhibit the typical signs of ischemia due to the intense analgesics used during the perioperative phase. They are consequently ignored in ordinary medical care without diligent supervision.
- Designed and organized treatment modalities for postoperative myocardial infarction in the specific patient require a deeper knowledge of the underlying pathophysiology.
Summary
As part of a program of close monitoring and feedback, the causes of perioperative myocardial infarctions were found in this prospective multicenter study. Two independent doctors uniformly arbitrated them centered on all the data gathered during the medically associated perioperative myocardial infarction work-up, including cardiac imaging, among successive elevated-risk individuals facing major non-cardiac surgery. Transient ischemic failure, tachyarrhythmia, type 1 myocardial infarction, septic shock, collapsed lungs, and probably type 2 cardiomyopathy are all cardiac diseases that can produce perioperative myocardial infarction. Extra-cardiac diseases include conditions like septic shock and deep vein thrombosis. Significant adverse cardiac episodes, such as myocardial ischemia, acute heart failure, life-threatening tachycardia, cardiac mortality, and all-cause mortality, were evaluated during a one-year follow-up.
13.1% of the elevated risk participants in this multicenter prospective research who underwent cardiac surgery suffered a perioperative myocardial infarction, especially type 2 myocardial infarction accounting for over 75% of perioperative myocardial infarction incidents. Regardless of the cause, individuals with this disease had a significantly greater rate of significant adverse cardiac incidents within one year than the ones without perioperative myocardial infarction.
1016 of the 7754 participants had a perioperative myocardial infarction. At least one major cardiovascular event occurred among these patients, and 818 participants died within a year.
These results demonstrate that perioperative myocardial infarction, linked to a poor 1-year prognosis, affects more than 1 in 8 individuals with elevated risk. At one year, most perioperative myocardial infarction pathologies have unacceptable elevated incidences of major cardiac events and all-cause mortality, underscoring the critical necessity for more rigorous therapies.
With the availability of scientifically proven treatments for acute heart failure, tachyarrhythmia, and type 1 myocardial infarction, determining the fundamental pathophysiology appears to be of utmost relevance. These results support conclusions from earlier pilot studies that type 1 myocardial infarction is probably not the primary cause of perioperative heart conditions.
Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac798/7006478
References Puelacher, C., Gualandro, D. M., Glarner, N., Lurati Buse, G., Lampart, A., Bolliger, D., Steiner, L. A., Grossenbacher, M., Burri-Winkler, K., Gerhard, H., Kappos, E. A., Clerc, O., Biner, L., Zivzivadze, Z., Kindler, C., Hammerer-Lercher, A., Filipovic, M., Clauss, M., Gürke, L., … Pargger, M. (2023). Long-term outcomes of perioperative myocardial infarction/injury after non-cardiac surgery. European Heart Journal, ehac798. https://doi.org/10.1093/eurheartj/ehac798
