Long-term outcomes of perioperative myocardial infarction/injury after non-cardiac surgery.

Perioperative myocardial infarction/injury (PMI) following non-cardiac surgery is a frequent cardiac complication. Better understanding of the underlying aetiologies and outcomes is urgently needed. Aetiologies of PMIs detected within an active surveillance and response programme were centrally adjudicated by two independent physicians based on all information obtained during clinically indicated PMI work-up including cardiac imaging among consecutive high-risk patients undergoing major non-cardiac surgery in a prospective multicentre study. PMI aetiologies were hierarchically classified into 'extra-cardiac' if caused by a primarily extra-cardiac disease such as severe sepsis or pulmonary embolism; and 'cardiac', further subtyped into type 1 myocardial infarction (T1MI), tachyarrhythmia, acute heart failure (AHF), or likely type 2 myocardial infarction (lT2MI). Major adverse cardiac events (MACEs) including acute myocardial infarction, AHF (both only from day 3 to avoid inclusion bias), life-threatening arrhythmia, and cardiovascular death as well as all-cause death were assessed during 1-year follow-up. Among 7754 patients (age 45-98 years, 45% women), PMI occurred in 1016 (13.1%). At least one MACE occurred in 684/7754 patients (8.8%) and 818/7754 patients died (10.5%) within 1 year. Outcomes differed starkly according to aetiology: in patients with extra-cardiac PMI, T1MI, tachyarrhythmia, AHF, and lT2MI 51%, 41%, 57%, 64%, and 25% had MACE, and 38%, 27%, 40%, 49%, and 17% patients died within 1 year, respectively, compared to 7% and 9% in patients without PMI. These associations persisted in multivariable analysis. At 1 year, most PMI aetiologies have unacceptably high rates of MACE and all-cause death, highlighting the urgent need for more intensive treatments. https://clinicaltrials.gov/ct2/show/NCT02573532.

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© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

Déclaration de conflit d'intérêts

Conflict of interest C.P. reports grants from the Swiss Heart Foundation, Roche Diagnostics and the University Hospital Basel dedicated to conduct of this study, as well as chaired an advisory board for Roche Diagnostics, during the conduct of the study. D.M.G. has received research grants from FAPESP (Sao Paulo Research Foundation) for the submitted work and speaker or consulting honoraria from Roche, outside the submitted work. N.G. reports grants from the Swiss Heart Foundation. G.L.B. reports grants from University of Basel as well as co-chaired an advisory board for Roche Diagnostics, during the conduct of the study, as well as support from the Clinical Research Program of the University of Basel. A.H.-L. reports speaker or consulting honoraria from Roche, Abbott and Beckman, outside the submitted work. C.K. reports grants from Forschungsfond Kantonsspital Aarau, during the conduct of the study. M.B. reports travel grants from the Research Fellowship of the Department of Surgery University Hospital Basel. M.F. reports grants from the Swiss National Science Foundation and the Cantonal Hospital St. Gallen outside of the submitted work. Dr. Arslani has received a research grant from the Swiss Academy of Medical Sciences and the Bangerter Foundation (YTCR 09/19) and the Swiss National Science Foundation (P500PM_202963) outside of the submitted work. B.C. reports grants from Conselho Nacional de Desenvolvimento Científico (CNPQ) and FAPESP (Sao Paulo Research Foundation) outside the submitted work. C.M. reports grants from the Swiss Heart Foundation, the Swiss National Science Foundation, the University Hospital Basel, the University of Basel, and grants and non-financial support from several diagnostic companies during the conduct of the study, as well as grants, personal fees and non-financial support from several diagnostic companies outside the submitted work. All other authors report no conflicts of interest.