TOPLINE:

Among patients at high risk who developed perioperative myocardial infarction (MI) or myocardial injury after major noncardiac surgery, evaluation by a cardiologist after surgery was linked to lower risks for major adverse cardiac events and all-cause death at 1 year than no cardiologist evaluation.

METHODOLOGY:

• In this prespecified analysis of a prospective study, researchers evaluated whether being evaluated by a cardiologist after surgery was linked to better outcomes in patients who developed perioperative MI or myocardial injury after major noncardiac surgery.
• The study included adults at high risk who underwent major inpatient noncardiac surgery at two Swiss hospitals between October 2014 and September 2019. Patients were considered high risk if aged 65 years or older or aged 45 years or older with known cardiovascular disease.
• Cardiac troponin levels were measured before surgery and on postoperative days 1 and 2. Perioperative MI or myocardial injury was defined as a rise in troponin levels within 3 days after surgery (≥ 14 ng/L for high-sensitivity cardiac troponin T or ≥ 45 ng/L for sensitive cardiac troponin I), regardless of symptoms.
• Researchers compared patients who were evaluated postoperatively by a cardiologist with those who were not, primarily because cardiology staff were unavailable on weekends or holidays or due to other competing clinical demands.
• The primary outcome was the occurrence of major adverse cardiac events — defined as a composite of cardiovascular death, MI, acute heart failure, or life-threatening arrhythmia — over a follow-up duration of 365 days after surgery.

TAKEAWAY:

• Among the 14,294 enrolled patients at high risk, 1048 experienced a perioperative MI or myocardial injury and were eligible for analysis (median age, 77 years; 44.8% women).
• Overall, 58.6% of eligible patients were evaluated by a cardiologist after surgery.
• In adjusted analyses, patients evaluated by a cardiologist after surgery had a 46% lower risk for major adverse cardiac events (P = .001) and a 35% lower risk for all-cause death (P = .037) than those not evaluated. Multiple sensitivity analyses confirmed these findings.
• Patients evaluated by cardiologists were more likely to undergo noninvasive cardiac imaging and receive dual antiplatelet and statin therapy than those not evaluated by cardiologists.

IN PRACTICE:

“[The findings] support current ESC guidelines on cardiovascular assessment for noncardiac surgery, emphasizing interdisciplinary care, including cardiologist involvement, for high-risk patients developing PMI [perioperative MI],” the researchers wrote.

“They highlight the operational challenges in implementing routine cardiologist evaluation in the postoperative care of patients developing PMI,” they added.

SOURCE:

The study was led by Noemi Glarner, MD, PhD, and Christian Puelacher, MD, PhD, of University Hospital Basel in Basel, Switzerland. It was published online on January 30 in European Heart Journal.

LIMITATIONS:

The study was a nonrandomized comparison; thus, residual confounding could not be ruled out. Individual treatment decisions of cardiologists varied and adherence to the recommended protocol was not formally measured. The study excluded patients receiving palliative care and followed patients for only 1 year.

DISCLOSURES:

The study received support from multiple organizations, including the Swiss Heart Foundation, Swiss National Science Foundation, University Hospital Basel, University of Basel, and from companies including Roche, Abbott Diagnostics, and Boehringer Ingelheim (Germany). Several authors reported receiving grants, honoraria, contracts, or having other financial and nonfinancial ties with several organizations, including the funding agencies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.