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. 2025 Jun 4:14:100422.
doi: 10.1016/j.bjao.2025.100422. eCollection 2025 Jun.

Long-term outcomes of time-dependent phenotypes of perioperative myocardial injury☆

Mikael Fält  1 , Rasmus Åhman  1 , Fredrik Hammarskjöld  2 , Sara Lyckner  3 , Monir Jawad  4   5 , Ulrika Andersson  6 , Mats Fredrikson  7 , Jesper Sperber  3 , Louise Elander  8   9 , Lina De Geer  1 , Helén Didriksson  1 , Carina Jonsson  1 , Henrik Andersson  1 , Michelle S Chew  1   10
Affiliations

Long-term outcomes of time-dependent phenotypes of perioperative myocardial injury☆

Mikael Fält et al. BJA Open. .

Abstract

Background: Perioperative myocardial injury (PMI) is associated with increased short-term major adverse cardio- and cerebrovascular events (MACCE) and mortality. We evaluated how different phenotypes of PMI based on timing of injury impact long-term MACCE and mortality among patients undergoing major noncardiac surgery (NCS).

Methods: A prospective, observational study was carried out in 1290 patients aged ≥50 yr undergoing major noncardiac surgery. High-sensitivity cardiac troponin T (hs-cTnT) was measured before surgery and up to 3 days after surgery. Patients were classified into four groups: (1) no hs-cTnT elevation, (2) isolated preoperative hs-cTnT increases, (3) normal preoperative hs-cTnT with perioperative elevation, and (4) increased preoperative hs-cTnT with perioperative elevation. The main outcomes were MACCE and mortality up to 3 yr after operation.

Results: At 3-yr follow-up, MACCE had occurred in 17.1%, 37.9%, 45.2%, and 50.7% and mortality was 21.4%, 30.3%, 30.1%, and 33.8% in groups 1-4, respectively. All PMI phenotypes were independently associated with MACCE. Patients with 'normal preoperative hs-cTnT with perioperative elevation' appeared to have the highest risk. In this phenotype, the risk was greatest at 30 days (adjusted odds ratio, 4.5; 95% confidence interval, 2.3-8.8) and persisted over 3 yr (adjusted odds ratio, 3.5; 95% confidence interval, 2.0-5.9). PMI was associated with increased mortality, but the relationship was not sustained after multivariable adjustment.

Conclusions: Increased hs-cTnT based on timing identifies prognostically important subgroups. Perioperative increases, regardless of preoperative levels, are associated with a high risk of MACCE that is sustained up to 3 yr after surgery. This supports the use of time-based PMI phenotypes for prognostic enrichment studies to mitigate the risk of MACCE.

Clinical trial registration: NCT03436238.

Keywords: MACE; MINS; biomarker; cardiac troponins; high-sensitivity cardiac troponin T; major adverse cardiovascular events; myocardial injury; perioperative.

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Conflict of interest statement

MSC has received speaker's fees and honoraria from Edwards Lifesciences and AOP Health outside the submitted work and is an editorial board member of the British Journal of Anaesthesia. The other authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Study flowchart. hs-cTnT, high-sensitivity cardiac troponin T.
Figure 2
Figure 2
Perioperative myocardial injury phenotypes and mortality. Cumulative all-cause mortality according to perioperative myocardial injury phenotype, including P-value from log-rank test. Periop, perioperative; preop, preoperative.
See this image and copyright information in PMC

References

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