Patient- and procedure-related factors in the pathophysiology of perioperative myocardial infarction/injury

Johanna Gueckel¹, Christian Puelacher², Noemi Glarner³, Danielle M Gualandro⁴, Ivo Strebel¹, Tobias Zimmermann³, Ketina Arslani¹, Reka Hidvegi⁵, Marcel Liffert⁵, Alessandro Genini⁵, Stella Marbot¹, Maria Schlaepfer³, Luzius A Steiner⁶, Daniel Bolliger⁶, Andreas Lampart⁷, Lorenz Gürke⁸, Christoph Kindler⁹, Stefan Schären¹⁰, Stefan Osswald¹, Martin Clauss¹¹, Daniel Rikli¹¹, Giovanna Lurati Buse¹², Christian Mueller³; BASEL-PMI Investigators and contributors

Collaborators, Affiliations

Collaborators

BASEL-PMI Investigators and contributors:
Patrick Badertscher¹, Jasper Boeddinghaus¹, Andreas Buser¹³, Michael Freese¹, Angelika Hammerer-Lercher¹⁴, Luca Koechlin¹⁵, Pedro Lopez-Ayala¹, Arne Mehrkens¹⁰, Edin Mujagic⁸, Thomas Nestelberger¹⁶, Alexandra Prepoudis¹, Sandra Mitrovic¹⁷, Katharina Rentsch¹⁷, Esther Seeberger¹, Ronja Vogt¹, Joan Walter¹, Karin Wildi¹⁸, Thomas Wolff⁸, Desiree Wussler¹

Affiliations

¹ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
² Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland. Electronic address: christian.puelacher@usb.ch.
³ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
⁴ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, Brazil.
⁵ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Anesthesiology, University Hospital Basel, University of Basel, Switzerland.
⁶ Department of Anesthesiology, University Hospital Basel, University of Basel, Switzerland; Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland.
⁷ Department of Anesthesiology, University Hospital Basel, University of Basel, Switzerland.
⁸ Department of Vascular Surgery, University Hospital Basel, University of Basel, Switzerland.
⁹ Department of Anesthesiology, Cantonal Hospital Aarau, Switzerland.
¹⁰ Department of Spinal Surgery, University Hospital Basel, University of Basel, Switzerland.
¹¹ Department of Orthopedics, University Hospital Basel, University of Basel, Switzerland.
¹² Department of Anesthesiology, University Hospital Düsseldorf, Germany.
¹³ Department of Hematology and Blood Bank, University Hospital Basel, University of Basel, Switzerland.
¹⁴ Department of Laboratory Medicine, Cantonal Hospital Aarau, Switzerland.
¹⁵ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Switzerland.
¹⁶ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁷ Department of Laboratory Medicine, University Hospital Basel, University of Basel, Switzerland.
¹⁸ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Critical Care Research Group, the Prince Charles Hospital, Brisbane and the University of Queensland, Brisbane, Queensland, Australia.

PMID: 35026340
DOI: 10.1016/j.ijcard.2022.01.015

Observational Study

Patient- and procedure-related factors in the pathophysiology of perioperative myocardial infarction/injury

Johanna Gueckel et al. Int J Cardiol. 2022.

. 2022 Apr 15:353:15-21.

doi: 10.1016/j.ijcard.2022.01.015. Epub 2022 Jan 11.

Authors

Collaborators

BASEL-PMI Investigators and contributors:
Patrick Badertscher¹, Jasper Boeddinghaus¹, Andreas Buser¹³, Michael Freese¹, Angelika Hammerer-Lercher¹⁴, Luca Koechlin¹⁵, Pedro Lopez-Ayala¹, Arne Mehrkens¹⁰, Edin Mujagic⁸, Thomas Nestelberger¹⁶, Alexandra Prepoudis¹, Sandra Mitrovic¹⁷, Katharina Rentsch¹⁷, Esther Seeberger¹, Ronja Vogt¹, Joan Walter¹, Karin Wildi¹⁸, Thomas Wolff⁸, Desiree Wussler¹

Affiliations

¹ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
² Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland. Electronic address: christian.puelacher@usb.ch.
³ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
⁴ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, Brazil.
⁵ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Anesthesiology, University Hospital Basel, University of Basel, Switzerland.
⁶ Department of Anesthesiology, University Hospital Basel, University of Basel, Switzerland; Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland.
⁷ Department of Anesthesiology, University Hospital Basel, University of Basel, Switzerland.
⁸ Department of Vascular Surgery, University Hospital Basel, University of Basel, Switzerland.
⁹ Department of Anesthesiology, Cantonal Hospital Aarau, Switzerland.
¹⁰ Department of Spinal Surgery, University Hospital Basel, University of Basel, Switzerland.
¹¹ Department of Orthopedics, University Hospital Basel, University of Basel, Switzerland.
¹² Department of Anesthesiology, University Hospital Düsseldorf, Germany.
¹³ Department of Hematology and Blood Bank, University Hospital Basel, University of Basel, Switzerland.
¹⁴ Department of Laboratory Medicine, Cantonal Hospital Aarau, Switzerland.
¹⁵ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Switzerland.
¹⁶ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁷ Department of Laboratory Medicine, University Hospital Basel, University of Basel, Switzerland.
¹⁸ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Critical Care Research Group, the Prince Charles Hospital, Brisbane and the University of Queensland, Brisbane, Queensland, Australia.

PMID: 35026340
DOI: 10.1016/j.ijcard.2022.01.015

Abstract

Background: Perioperative myocardial infarction/injury (PMI) is a frequent, often missed and incompletely understood complication of noncardiac surgery. The aim of this study was to evaluate whether patient- or procedure-related factors are more strongly associated to the development of PMI in patients undergoing repeated noncardiac surgery.

Methods: In this prospective observational study, patient- and procedure-related factors were evaluated for contribution to PMI using: 1) logistic regression modelling with PMI as primary endpoint, 2) evaluation of concordance of PMI occurrence in the first and the second noncardiac surgery (surgery 1 and 2). and 3) the correlation of the extent of cardiomyocyte injury quantified by high-sensitivity cardiac troponin T between surgery 1 and 2. The secondary endpoint was all-cause mortality associated with PMI reoccurrence in surgery 2.

Results: Among 784 patients undergoing repeated noncardiac surgery (in total 1'923 surgical procedures), 116 patients (14.8%) experienced PMI during surgery 1. Among these, PMI occurred again in surgery 2 in 35/116 (30.2%) patients. However, the vast majority of patients developing PMI during surgery 2 (96/131, 73.3%) had not developed PMI during surgery 1 (phi-coefficient 0.150, p < 0.001). The correlation between the extent of cardiomyocyte injury occurring during surgery 1 and 2 was 0.153. All-cause mortality following a second PMI in surgery 2 was dependent on time since surgery (adjusted hazard ratio 5.6 within 30 days and 2.4 within 360 days).

Conclusions: In high-risk patients, procedural factors are more strongly associated with occurrence of PMI than patient factors, but patient factors are also contributors to the occurrence of PMI.

Keywords: Multiple noncardiac surgery; Perioperative care; Perioperative myocardial infarction; Perioperative myocardial injury; Recurrent AMI; Repeated noncardiac surgery.

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Patient- and procedure-related factors in the pathophysiology of perioperative myocardial infarction/injury

Collaborators

Affiliations

Patient- and procedure-related factors in the pathophysiology of perioperative myocardial infarction/injury

Authors

Collaborators

Affiliations

Abstract

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical