Association between cardiologist evaluation and mortality in myocardial injury after non-cardiac surgery

Objective Myocardial injury after non-cardiac surgery (MINS) is strongly associated with mortality, but few studies assessed treatment strategies. This study aimed to identify whether evaluation by cardiologists could reduce mortality in MINS patients. Methods From a single-centre retrospective cohort, we enrolled a total of 5633 adult patients diagnosed with MINS between January 2010 and June 2019. The patients were divided into two groups based on evaluation by cardiologist, which was defined as a cardiology consultation or transfer to the cardiology department. For the outcome, 30-day mortality was compared in crude and propensity-score matched populations. Results Of a total of 5633 patients, 2120 (37.6%) were evaluated by cardiologists and 3513 (62.4%) were not. Mortality during the first 30 days after surgery was significantly lower in MINS patients who were evaluated by cardiologists compared with those who were not (5.8% vs 8.3%; HR, 0.64; 95% CI 0.51 to 0.80; p<0.001 for all-cause mortality and 1.6% vs 2.0; HR 0.62; 95% CI 0.40 to 0.96; p=0.03 for cardiovascular mortality). The propensity score matched analysis showed similar results (5.6% vs 8.6%; HR 0.64; 95% CI 0.50 to 0.81; p<0.001 for all-cause mortality and 1.3% vs 2.2%; HR 0.58; 95% CI 0.35 to 0.95; p=0.03 for cardiovascular mortality). Conclusions Cardiologist evaluation was associated with lower mortality in patients diagnosed with MINS. Further studies are needed to identify effective treatment strategies for MINS. Trial registration number KCT0004244.

[1]  M. Vaduganathan,et al.  Cardiologist Evaluation of Patients with Type 2 Myocardial Infarction. , 2020, Circulation. Cardiovascular quality and outcomes.

[2]  Kyunga Kim,et al.  Postoperative statin treatment may be associated with improved mortality in patients with myocardial injury after noncardiac surgery , 2020, Scientific Reports.

[3]  P. Devereaux,et al.  Myocardial injury after non-cardiac surgery: diagnosis and management. , 2019, European heart journal.

[4]  D. Sessler,et al.  Myocardial Injury After Noncardiac Surgery: Preoperative, Intraoperative, and Postoperative Aspects, Implications, and Directions. , 2019, Anesthesia and analgesia.

[5]  J. Durand,et al.  DIAGNOSTIC PERFORMANCE OF HIGH SENSITIVITY TROPONIN IN CANCER PATIENTS , 2019, Journal of the American College of Cardiology.

[6]  Jeroen J. Bax,et al.  Fourth universal definition of myocardial infarction (2018). , 2018, European heart journal.

[7]  O. Barbarash,et al.  FOURTH UNIVERSAL DEFINITION OF MYOCARDIAL INFARCTION. FOCUS ON THE TYPE 2 MYOCARDIAL INFARCTION , 2018, Fundamental and Clinical Medicine.

[8]  A. Jaffe,et al.  Comparison of high‐sensitivity cardiac troponin I and T for the prediction of cardiac complications after non‐cardiac surgery , 2018, American heart journal.

[9]  G. Guyatt,et al.  Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial , 2018, The Lancet.

[10]  G. Guyatt,et al.  Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost-consequence analysis. , 2018, Canadian journal of surgery. Journal canadien de chirurgie.

[11]  K. Carriere,et al.  Association Between Presence of a Cardiac Intensivist and Mortality in an Adult Cardiac Care Unit. , 2016, Journal of the American College of Cardiology.

[12]  D. Sessler,et al.  Perioperative Troponin Screening , 2016, Anesthesia and analgesia.

[13]  S. Davies,et al.  Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS). , 2014, Journal of thoracic disease.

[14]  Catch Investigators.  Tinzaparin vs warfarin for treatment of acute venous thromboembolism in patients with active cancer: A randomized clinical trial , 2015 .

[15]  Eric E. Smith,et al.  2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards). , 2015, Circulation.

[16]  A. Khorana,et al.  Tinzaparin vs Warfarin for Treatment of Acute Venous Thromboembolism in Patients With Active Cancer: A Randomized Clinical Trial. , 2015, JAMA.

[17]  Eric E. Smith,et al.  2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards). , 2015, Journal of the American College of Cardiology.

[18]  P. Coriat,et al.  The Long-Term Impact of Early Cardiovascular Therapy Intensification for Postoperative Troponin Elevation After Major Vascular Surgery , 2014, Anesthesia and analgesia.

[19]  J. Knuuti,et al.  New ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. , 2014, European heart journal.

[20]  Pavel S. Roshanov,et al.  Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes , 2014, Anesthesiology.

[21]  H. Berkenstadt,et al.  Evaluation of the impact of a quality improvement program and intensivist-directed ICU team on mortality after cardiac surgery. , 2013, Journal of cardiothoracic and vascular anesthesia.

[22]  E. Clambey,et al.  Perioperative Organ Injury , 2013, Anesthesiology.

[23]  H. Nathoe,et al.  Myocardial Injury After Noncardiac Surgery and its Association With Short-Term Mortality , 2013, Circulation.

[24]  P. Libby.  Mechanisms of acute coronary syndromes and their implications for therapy. , 2013, The New England journal of medicine.

[25]  J. Savige,et al.  Does cardiology intervention improve mortality for post-operative troponin elevations after emergency orthopaedic-geriatric surgery? A randomised controlled study. , 2012, Injury.

[26]  G. Guyatt,et al.  Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. , 2012, JAMA.

[27]  Denis Xavier,et al.  Characteristics and Short-Term Prognosis of Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery , 2011, Annals of Internal Medicine.

[28]  A. Hoes,et al.  Sensitivity analyses to estimate the potential impact of unmeasured confounding in causal research. , 2010, International journal of epidemiology.

[29]  A. Menkis,et al.  Impact of 24-hour in-house intensivists on a dedicated cardiac surgery intensive care unit. , 2009, The Annals of thoracic surgery.

[30]  O. Gajic,et al.  Physician staffing models and patient safety in the ICU. , 2009, Chest.

[31]  Sylvie Chevret,et al.  Sample size formula for proportional hazards modelling of competing risks , 2004, Statistics in medicine.

[32]  Peter J Pronovost,et al.  Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. , 2002, JAMA.

[33]  E F Cook,et al.  Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. , 1999, Circulation.