Management of Patients with Myocardial Injury After Noncardiac Surgery: A Retrospective Chart Review

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.