Cardiovascular Imaging Following Perioperative Myocardial Infarction/Injury

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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PERIOPERACINIS MIOKARDO INFARKTAS

Sveikatos mokslai ◽

10.5200/sm-hs.2013.129 ◽

2013 ◽

Vol 23 (6) ◽

pp. 29-34

Author(s):

Andrius Macas ◽

Giedrė Bakšytė ◽

Laura Šilinskytė ◽

Jūratė Petrauskaitė

Keyword(s):

Myocardial Infarction ◽

Cardiac Surgery ◽

Oxygen Supply ◽

Plaque Rupture ◽

Perioperative Period ◽

Vascular Complication ◽

Early Postoperative Period ◽

Hospital Length Of Stay ◽

Perioperative Myocardial Infarction ◽

Risk Patients

Perioperative myocardial infarction (PMI) is defined as myocardial infarction (MI) during perioperative period (24-72 hours after non cardiac surgery). Worldwide, over 200 million adults have major non-cardiac surgery each year, and several million experience a major vascular complication (e.g.: nonfatal myocardial infarction). The prevalence of PMI for low risk patients without ischemic heart disease is from 0.3 to 3%, while for medium and high risk patients with coronary artery disease increases to 30%. It is believed that plaque rupture and myocardial oxygen supply-demand imbalance is the main reason of perioperative myocardial infarction. Mostly oxygen supply-demand imbalance predominates in the early postoperative period. Plaque rupture appears to be a more random event, distributed over the entire perioperative admission. Most patients with a perioperative MI do not experience ischemic symptoms, because of sedation and analgesia during surgery procedure. This is the reason why routine monitoring of troponin levels and electrocardiography in at-risk patients are needed after surgery to detect most MI. In 90% of cases troponin level inceases during the first 24 hours after surgery. Risk factors detection, serial troponin evaluation and specialised treatment can reduce hospital length of stay, treatment costs and PMI mortality.

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