Multicenter Study

. 2022 Mar 15;12(1):4447.

doi: 10.1038/s41598-022-08261-6.

Cardiovascular imaging following perioperative myocardial infarction/injury

Ketina Arslani^#¹, Danielle M Gualandro^#^{2

3}, Christian Puelacher^{1

4}, Giovanna Lurati Buse^{5

6}, Andreas Lampart⁶, Daniel Bolliger⁶, David Schulthess¹, Noemi Glarner¹, Reka Hidvegi^{1

7}, Christoph Kindler⁸, Steffen Blum¹, Francisco A M Cardozo⁹, Bruno Caramelli⁹, Lorenz Gürke¹⁰, Thomas Wolff¹⁰, Edin Mujagic¹⁰, Stefan Schaeren¹¹, Daniel Rikli¹², Carlos A Campos⁹, Gregor Fahrni¹, Beat A Kaufmann¹, Philip Haaf¹, Michael J Zellweger¹, Christoph Kaiser¹, Stefan Osswald¹, Luzius A Steiner⁶, Christian Mueller¹; BASEL-PMI Investigators

Collaborators, Affiliations

Collaborators

BASEL-PMI Investigators:
Johanna Gueckel, Marcel Liffert, Gabriel Kanhouche, Lorraine Sazgary, Pai C Yu, Alexandra Prepoudis, Samyut Shrestha, Pedro Lopez-Ayala, Michael Freese, Sandra Mitrovic, Katharina Rentsch, Angelika Hammerer-Lerchner

Affiliations

¹ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
² Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland. danielle.gualandro@usb.ch.
³ Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. danielle.gualandro@usb.ch.
⁴ Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
⁵ Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.
⁶ Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland.
⁷ Department of Anaesthesiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
⁸ Department of Anaesthesiology, Kantonsspital Aarau, Aarau, Switzerland.
⁹ Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
¹⁰ Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
¹¹ Department of Spinal Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
¹² Department Orthopedic Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.

^# Contributed equally.

PMID: 35292719
PMCID: PMC8924205
DOI: 10.1038/s41598-022-08261-6

Multicenter Study

Cardiovascular imaging following perioperative myocardial infarction/injury

Ketina Arslani et al. Sci Rep. 2022.

. 2022 Mar 15;12(1):4447.

doi: 10.1038/s41598-022-08261-6.

Authors

Collaborators

BASEL-PMI Investigators:
Johanna Gueckel, Marcel Liffert, Gabriel Kanhouche, Lorraine Sazgary, Pai C Yu, Alexandra Prepoudis, Samyut Shrestha, Pedro Lopez-Ayala, Michael Freese, Sandra Mitrovic, Katharina Rentsch, Angelika Hammerer-Lerchner

Affiliations

¹ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
² Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland. danielle.gualandro@usb.ch.
³ Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. danielle.gualandro@usb.ch.
⁴ Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
⁵ Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany.
⁶ Department of Anaesthesiology, University Hospital Basel, University Basel, Basel, Switzerland.
⁷ Department of Anaesthesiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
⁸ Department of Anaesthesiology, Kantonsspital Aarau, Aarau, Switzerland.
⁹ Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
¹⁰ Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
¹¹ Department of Spinal Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.
¹² Department Orthopedic Surgery, University Hospital Basel, University of Basel, Basel, Switzerland.

^# Contributed equally.

PMID: 35292719
PMCID: PMC8924205
DOI: 10.1038/s41598-022-08261-6

Abstract

Patients developing perioperative myocardial infarction/injury (PMI) have a high mortality. PMI work-up and therapy remain poorly defined. This prospective multicenter study included high-risk patients undergoing major non-cardiac surgery within a systematic PMI screening and clinical response program. The frequency of cardiovascular imaging during PMI work-up and its yield for possible type 1 myocardial infarction (T1MI) was assessed. Automated PMI detection triggered evaluation by the treating physician/cardiologist, who determined selection/timing of cardiovascular imaging. T1M1 was considered with the presence of a new wall motion abnormality within 30 days in transthoracic echocardiography (TTE), a new scar or ischemia within 90 days in myocardial perfusion imaging (MPI), and Ambrose-Type II or complex lesions within 7 days of PMI in coronary angiography (CA). In patients with PMI, 21% (268/1269) underwent at least one cardiac imaging modality. TTE was used in 13% (163/1269), MPI in 3% (37/1269), and CA in 5% (68/1269). Cardiology consultation was associated with higher use of cardiovascular imaging (27% versus 13%). Signs indicative of T1MI were found in 8% of TTE, 46% of MPI, and 63% of CA. Most patients with PMI did not undergo any cardiovascular imaging within their PMI work-up. If performed, MPI and CA showed high yield for signs indicative of T1MI.Trial registration: https://clinicaltrials.gov/ct2/show/NCT02573532 .

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Conflict of interest statement

Dr. Arslani has received a research grant from the Swiss Academy of Medical Sciences and the Bangerter Foundation (YTCR 09/19) and the Swiss National Science Foundation (P500PM_202963). Dr. Puelacher reports grants from PhD Educational Platform for Health Sciences, Roche Diagnostics and the University Hospital Basel during the conduct of the study. Dr. Gualandro has received research grants from FAPESP (Sao Paulo Research Foundation) for the submitted work, grants from the Swiss Heart Foundation and consulting honoraria from Roche, outside the submitted work. Dr. Mueller reports grants from the Swiss Heart Foundation and grants and non-financial support from several diagnostic companies during the conduct of the study, as well as grants, personal fees, and non-financial support from several diagnostic companies outside the submitted work. Dr. Kindler reports grants from the Forschungsfond Kantonsspital Aarau during the conduct of the study. Dr. Blum reports a grant from the Mach-Gaensslen Foundation outside the submitted work. All other authors report no conflicts of interest.

Figures

**Figure 1**
Patient flowchart showing number of patients assessed, number of patient excluded and reasons for exclusion. PMI: perioperative myocardial infarction/injury; T1MI: Type 1 myocardial infarction.

**Figure 2**
Patient level analysis: Cardiac imaging modalities in cardiac PMI. (A) All patients. (B) Patients with no cardiology consultation. (C) Patients with cardiology consultation. Pie chart showing the frequency of cardiac imaging modalities in general and in patients with and without cardiology consultation. MPI: myocardial perfusion imaging. TTE: transthoracic echocardiography.

**Figure 3**
Imaging modality level analysis. (A) Transthoracic echocardiography. (B) Myocardial perfusion imaging. (C) Coronary angiography. Pie chart showing the yield for signs of type 1 MI in different cardiac imaging modalities. MI: Myocardial infarction.

**Figure 4**
Details and summary of information collected from coronary angiography records. CAD: coronary artery disease. TIMI: Thrombolysis in Myocardial Infarction.

See this image and copyright information in PMC

References

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1. Puelacher C, et al. Perioperative myocardial injury after noncardiac surgery: Incidence, mortality, and characterization. Circulation. 2018;137(12):1221–1232. doi: 10.1161/CIRCULATIONAHA.117.030114. - DOI - PubMed
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Cardiovascular imaging following perioperative myocardial infarction/injury

Collaborators

Affiliations

Cardiovascular imaging following perioperative myocardial infarction/injury

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

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Associated data

LinkOut - more resources

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