Wang Michael Ke, Sabac Denise, Sadhak Roshan, Ajay Amy, Benayon Myles, Borges Flavia K, Cha Yevin, Conen David, Coomber Michael, Fuller Katherine, Gill Diljit, Jayachandiran Rahul, Koubaesh Carol, Latchupatula Lekhini, Moosa Sabreena, Ofori Sandra, Pasumarthi Keerthana, Patel Ameen, Samari Saif, Blum Steffen, Suresh Mallika, Tandon Vikas, Devereaux P J, Marcucci Maura
Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
CJC Open. 2024 Oct 11;7(1):103-109. doi: 10.1016/j.cjco.2024.10.004. eCollection 2025 Jan.
Myocardial injury after noncardiac surgery (MINS) is associated with an increased incidence of cardiac morbidity and mortality. Little is known about how these patients are managed.
We performed a single-centre retrospective chart review of patients referred to a postoperative clinic with the diagnosis of MINS. Patients were included if they attended the clinic at least once between September 2018 and December 2019. We extracted preoperative, in-hospital, and postdischarge data on cardiac investigations and medication use.
Of the 152 patients with MINS who were included, 34% had a history of coronary disease before MINS. The median peak high-sensitivity troponin I (hsTnI) level was 122 ng/L (interquartile range, 51-259), and 78% had no associated ischemic symptoms or electrocardiographic changes. Patients underwent echocardiography and nuclear stress imaging in 87% and 30% of cases, respectively. Of those who had cardiac investigations performed and no prior history of coronary artery disease, 23% (19 of 84) had ≥ 1 regional wall-motion abnormality on echocardiogram, and 39% (13 of 34) had evidence of ischemia on nuclear stress imaging. More patients were prescribed an antithrombotic and lipid-lowering drug at discharge (79%) and at their final clinic visit (86%), compared to the number before surgery (30%). A total of 57% of patients had changes made to ≥ 1 cardiovascular medication during clinic follow-up.
Patients with MINS followed in a postoperative clinic frequently had abnormal cardiac investigations and received medical optimization. Our findings suggest that postoperative clinics may represent an opportunity for risk mitigation after MINS, a possibility that deserves further evaluation.
非心脏手术后心肌损伤（MINS）与心脏发病率和死亡率的增加相关。对于这些患者的管理方式知之甚少。
我们对转诊至术后门诊诊断为MINS的患者进行了单中心回顾性病历审查。纳入2018年9月至2019年12月期间至少到门诊就诊一次的患者。我们提取了术前、住院期间和出院后关于心脏检查和药物使用的数据。
纳入的152例MINS患者中，34%在MINS发生前有冠心病病史。高敏肌钙蛋白I（hsTnI）水平的中位数峰值为122 ng/L（四分位间距，51 - 259），78%的患者无相关缺血症状或心电图改变。分别有87%和30%的患者接受了超声心动图和核素负荷成像检查。在进行了心脏检查且无冠心病病史的患者中，23%（84例中的19例）超声心动图显示≥1个节段性室壁运动异常，39%（34例中的13例）核素负荷成像有缺血证据。与手术前（30%）相比，更多患者在出院时（79%）和最后一次门诊就诊时（86%）接受了抗血栓和降脂药物治疗。在门诊随访期间，共有57%的患者至少有一种心血管药物发生了改变。
在术后门诊随访的MINS患者经常有异常的心脏检查结果并接受了药物优化治疗。我们的研究结果表明，术后门诊可能是MINS后降低风险的一个机会，这一可能性值得进一步评估。
