Work up to rule out perioperative myocardial infarction: is it overused?

Abstract Background: Patients developing perioperative myocardial infarction/injury(PMI) have high mortality. PMI work-up and therapy remain poorly defined.Methods: In a prospective multicenter study enrolling high-risk patients undergoing major non-cardiac surgery within a systematic PMI screening and clinical response program, the frequency of cardiovascular imaging during PMI work-up and its yield for possible type 1 myocardial infarction(T1MI) was assessed. Automated PMI detection triggered evaluation by the treating physician/ cardiologist on service, who determined selection/timing of cardiovascular imaging. In transthoracic echocardiography(TTE) a new wall motion abnormality within 30days, in myocardial perfusion imaging(MPI) a new scar or ischemia within 90days, and in coronary angiography(CA) Ambrose-Type II or complex lesions within 7days of PMI detection were considered indicative of T1MI. Results: In patients with PMI, 21%(268/1269) underwent at least one cardiac imaging modality. TTE was used in 13%(163/1269), MPI in 3%(37/1269), and CA in 5%(68/1269). Consultation by a cardiologist, was associated with higher use of cardiaovascular imaging(27% versus 13%). Signs indicative of T1MI were found in 8% of TTE, 46% of MPI, and in 63% of CA. Conclusion: Most patients with PMI did not receive any cardiovascular imaging within their PMI work-up. If performed, MPI and CA have high yield for signs indicative of T1MI. Study registration: https://clinicaltrials.gov/ct2/show/NCT02573532

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Therapeutic options in CABG patients with acute perioperative myocardial infarction: Interventional versus surgical therapy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2004-816603 ◽

2004 ◽

Vol 52 (S 1) ◽

Author(s):

G Nollert ◽

C Matt ◽

P Boeckstegers ◽

B Reichart ◽

C Vicol

Keyword(s):

Myocardial Infarction ◽

Surgical Therapy ◽

Therapeutic Options ◽

Perioperative Myocardial Infarction ◽

Cabg Patients

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Faculty Opinions recommendation of One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725420089.793507697 ◽

2015 ◽

Author(s):

Patrick Ray

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Rule Out

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Faculty Opinions recommendation of Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.9963956.10696054 ◽

2011 ◽

Author(s):

Thomas Slaughter

Keyword(s):

Myocardial Infarction ◽

Cohort Study ◽

Noncardiac Surgery ◽

Perioperative Myocardial Infarction ◽

Short Term

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Late Sequelae of Perioperative Myocardial Infarction

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(10)63672-7 ◽

1978 ◽

Vol 26 (3) ◽

pp. 208-214 ◽

Cited By ~ 30

Author(s):

John E. Codd ◽

Robert D. Wiens ◽

George C. Kaiser ◽

Hendrick B. Barner ◽

Denis H. Tyras ◽

...

Keyword(s):

Myocardial Infarction ◽

Late Sequelae ◽

Perioperative Myocardial Infarction

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Performance of the ESC 0/3-hour algorithm for rapid triage of myocardial infarction: systematic review and meta-analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1674 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Chiang ◽

C.H Chiang ◽

G.H Lee ◽

C.C Lee

Keyword(s):

Myocardial Infarction ◽

Predictive Value ◽

Meta Analysis ◽

Pooled Analysis ◽

Public Institution ◽

Systematic Evaluation ◽

Funding Source ◽

Cochrane Central Register ◽

Comparative Performance ◽

Rule Out

Abstract Objective The European Society of Cardiology (ESC) 0/3-hour algorithm is one of the most widely strategies used for rule-out or rule-in of acute myocardial infarction (AMI). However, a systematic evaluation of its performance has not been conducted. Furthermore, recent studies showed that the 0/3-hour algorithm is non-superior to the 0/1-hour algorithm. Purpose This study aims to summarize the safety and efficacy of the 0/3-hour algorithm and its comparative performance with the 0/1-hour algorithm. Methods We conducted literature search on PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published between 1 January 2008 and 31 May 2019. A bivariate random-effects meta-analysis was used to estimate the primary and secondary outcomes, defined as index myocardial infarction and triage efficacy, major adverse cardiac event (MACE) or mortality at 30 days, respectively. Results A total of 10,832 patients from 9 studies with a pooled AMI prevalence of 16% were analyzed. The 0/3-hour algorithm ruled out 69% of the patients with a pooled sensitivity of 94.2% [95% CI: 87.6%–97.4%] and negative predictive value of 98.6% [95% CI: 97.0%–99.4%]; 17% of the patients were ruled in with a pooled specificity of 94.9% [95% CI: 88.6%–97.8%] and positive predictive value of 72.9% [95% CI: 54.6%–85.7%]. The 30-day mortality and 30-day MACE for patients that were ruled out were 0.0% [95% CI: 0.0%–0.0%] and 1.4% [95% CI: 0.9%–2.0%], respectively. In a pooled analysis of 3 cohorts, the 0/3-hour algorithm had a non-superior sensitivity compared with the 0/1-hour algorithm (94.4% [95% CI: 87.0%–97.7%] vs. 98.4% [95% CI: 95.4%–99.7%]). The 0/3-hour algorithm also had a similar rule-out efficacy compared with the 0/1-hour algorithm (52% [95% CI: 39%–65%] vs. 53% [95% CI: 42%–64%]). Conclusion The widely used 0/3-hour algorithm has sensitivity substantially below the consensus goal of 99% and may not be sufficiently safe for triage of myocardial infarction. Furthermore, the 0/3-hour algorithm is not superior to the 0/1-hour algorithm despite the additional triage time. Performance of ESC 0/3-hour algorithm Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Taiwan National Ministry of Science and Technology Grants

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Screening for coronary artery disease in early surgical treatment of acute aortic valve infective endocarditis

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa313 ◽

2020 ◽

Author(s):

Wiebe G Knol ◽

Ali R Wahadat ◽

Jolien W Roos-Hesselink ◽

Nicolas M Van Mieghem ◽

Wilco Tanis ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Infective Endocarditis ◽

Perioperative Complications ◽

Invasive Coronary Angiography ◽

Perioperative Myocardial Infarction ◽

Non Invasive ◽

Estimated Risk ◽

Artery Disease

Abstract OBJECTIVES In patients with unknown coronary status undergoing surgery for acute infective endocarditis (IE), the need to screen for coronary artery disease (CAD) and the risk of embolization during invasive coronary angiography (ICA) are debated. Coronary computed tomography angiography (CCTA) is a non-invasive alternative in these patients. We aimed to evaluate the safety and feasibility of ICA and CCTA to diagnose CAD, and the necessity to treat CAD to prevent CAD-related postoperative complications. METHODS In this single-centre retrospective cohort study, all patients with acute aortic IE between 2009 and 2019 undergoing surgery were selected. Outcomes were any clinically evident embolization after preoperative ICA, in-hospital mortality, perioperative myocardial infarction or unplanned revascularization and postoperative renal function. RESULTS Of the 159 included patients, CAD status was already known in 14. No preoperative diagnostics for CAD was done in 46/145, a CCTA was performed in 54/145 patients and an ICA in 52/145 patients. Significant CAD was found after CCTA in 22% and after ICA in 21% of patients. In 1 of the 52 (2%) patients undergoing preoperative ICA, a cerebral embolism occurred. The rate of perioperative myocardial infarction or unplanned revascularization in patients not screened for CAD was 2% (1 out of 46 patients). CONCLUSIONS Although the risk of embolism after preoperative ICA is low, it should be carefully weighed against the estimated risk of CAD-related perioperative complications. CCTA can serve as a gatekeeper for ICA in most patients with acute aortic IE.

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