Patients who undergo non-heart surgery have an increased risk of developing perioperative myocardial injury, according to new Swiss research.
Scientists at the Cardiovascular Research Institute Basel, in Basel, say perioperative myocardial injury(PMI) is a frequently undetected complication following non-heart surgery and is strongly associated with death within 30 days after surgery.
The latest edition of Circulation, describes the BASEL-PMI study, which involved 2,018 patients with known or at high risk of developing heart disease. Between them, they had 2,546 non-cardiac surgeries at the University Hospital Basel in Switzerland between 2014 and 2015.
The research team measured the levels of the heart protein troponin before and after surgery to establish if there was any heart damage. Troponin can indicate damage to the heart even when the patient has no symptoms.
They found that one in seven patients over 65 years who had existing coronary artery disease, peripheral artery disease, or stroke developed PMI and that more than 90% of PMI patients reported typical chest pain.
Patients with PMI were six times more likely to die of any cause within 30 days compared to patients without the condition and the link to the high death rate lasted up to one year after surgery.
First author Dr Christian Puelacher said: “Patients with PMI are easily missed because they show no symptoms of heart disease in the majority of cases and only very rarely experience chest pain, which is the typical symptom of heart attack.
“Recognising PMI as a potential contributor to death after surgery might help improve the outcomes of non-cardiac surgery. However, since there are no clear treatment recommendations for these patients, treatment currently has to be tailored to each patient individually.
“Therefore, further research is needed to find optimal PMI management strategies following detection."
Lurati Buse G, Seeburger D, Sazgary L et al. Higher risk of dying due to heart cell damage without any symptoms occurs during or after non-heart surgery. Circulation 4 December 2017
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