#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Perioperative myocardial injury: Our fault or inflammation?


Authors: K. Skarvan
Authors‘ workplace: Departement Anästhesie und Intensivmedizin, Universitätssspital Basel, Švýcarsko
Published in: Anest. intenziv. Med., 29, 2018, č. 1, s. 14-22
Category: Anesthesiology - Review Article

Overview

In approximately one in ten patients undergoing major non-cardiac surgery, abnormal increases in plasma levels of high sensitivity cardiac troponin occur during the first postoperative days, suggesting postoperative myocardial injury. Most of these patients have no signs or symptoms of myocardial ischaemia or infarction. Nonetheless, they are at increased risk of both 30-day and long-term all-cause mortality as well as higher incidence of major cardiovascular adverse events, comparable to type 2 postoperative myocardial infarction. The myocardial injury is deemed to result from critical imbalance of myocardial O2 demand and supply. The pathophysiology, clinical implications and prevention of this condition are reviewed, and an alternative interpretation of the mechanisms causing cardiomyocyte necrosis – inflammation – is presented.

Keywords:
high sensitivity cardiac troponin – non-cardiac surgery – myocardial injury – ischaemia – mortality – adverse events – inflammation – statins


Sources

1. Skalická H, Moťovská Z, Toušek F. Summary of the 2014 ESC guidelines on non-cardiac surgery: cardiovascular assessment and management. Prepared by the Czech Society of cardiology. Cor et Vasa. 2015;57:e190–e213.

2. Landesberg G, Beattie WS, Mosseri M, Jaffe AS, Alpert JS. Perioperative myocardial infarction. Circulation. 2009; 119:2936–2944.

3. Devereaux PJ, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I, et al. Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med. 2011;154:523–528.

4. van Waes JA., Nathoen HM, de Graaff JC, Kemperman H, de Borst GJ, Peelen LM, et al. Myocardial injury after noncardiac surgery and its association with short-term mortality. Circulation. 2013;127:2264–2271.

5. van Waes JA, Grobben RB, Nathoe HM, Kemperman H, de Borst GJ, Peelen LM, et al. One-Year Mortality, Causes of Death, and Cardiac Interventions in Patients with Postoperative Myocardial Injury. Anesth Analg. 2016;123:29–37.

6. Smilowitz NR, Gupta N, Guo Y, Berger J, Bangalore S. Perioperative myocardial infarction associated with non-cardiac surgery. Eur Heart J. 2017;38:2409–2417.

7. Smilowitz NR, Gupta N, Ramakrishna NR, Gupta N, Guo Y, Berger JS , Bangalore S. Perioperative Major Adverse Cardiovascular and Cerebrovascular Events Associated With Noncardiac Surgery. JAMA Cardiol. 2017;2:181–187.

8. Parashar A, Agarwal S, Krishnaswamy A, Sud K, Poddar KL, Bassi M, et al. Percutaneous Intervention for Myocardial Infarction After Noncardiac Surgery: Patient Characteristics and Outcomes. J Am Coll Cardiol. 2016;68:329–338.

9. Dauerman HL. The Expanding Universe of Perioperative Myocardial Infarction. J Am Coll Cardiol. 2016;68:339–342.

10. Landesberg G, Mosseri M, Zahger D, Wolf Y, Perouansky M, Anner H, et al. Myocardial infarction after vascular surgery: the role of prolonged stress-induced, ST depression-type ischemia. J Am Coll Cardiol. 2001;37:1839–1845.

11. Filipovic M, Jeger R, Probst C, Girard T, Pfisterer M, Gurke L, et al. Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease. J Am Coll Cardiol. 2003;42:1767–1776.

12. Ekeloef S, Alamili M, Devereaux PJ, Gogenur I. Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis. Br J Anaesth. 2016;117:559–568.

13. Giannitsis E, Kurz K, Hallermayer K, Jarausch J, JaffeH AS, Katus A. Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem. 2010;56:254–261.

14. Park KC, Gaze DC, Collinson PO, Marber MS. Cardiac troponins: from myocardial infarction to chronic disease. Cardiovasc Research. 2017;113:1708–1718.

15. Twerenbold R, Boeddinghaus J, Nestelberger T, Wildi K, Rubini Gimenez M, Badertscher P, et al. Clinical Use of High-Sensitivity Cardiac Troponin in Patients With Suspected Myocardial Infarction. J Am Coll Cardiol. 2017;70:996–1012.

16. White HD. Pathobiology of troponin elevations: do elevations occur with myocardial ischemia as well as necrosis? J Am Coll Cardiol. 2011;57:2406–2408.

17. Eggers KM, Venge P, P. Lindahl B., Lind L. Cardiac troponin I levels measured with a high-sensitive assay increase over time and are strong predictors of mortality in an elderly population. J Am Coll Cardiol. 2013.61:1906–1913.

18. Willeit P, Welsh P, Evans JDW, Tschiderer L, Boachie C, Jukema JW, et al. High-Sensitivity Cardiac Troponin Concentration and Risk of First-Ever Cardiovascular Outcomes in 154,052 Participants. J Am Coll Cardiol. 2017;70:558–568.

19. Botto F, Alonso-Coello P, Chan MT, Villar JC, Xavier D, Srinathan S, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014;120:564–578.

20. Maile MD, Jewell ES, Engoren MC. Timing of Preoperative Troponin Elevations and Postoperative Mortality After Noncardiac Surgery. Anesth Analg. 2016;123:135–140.

21. Noordzij PG, van Geffen O, Dijkstra IM, Boerma D, Meinders AJ, Rettig TC, et al. High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery. Br J Anaesth. 2015;114:909–918.

22. Devereaux PJ, Biccard BM, Sigamani A, Xavier D, Chan MTV, Srinathan SK, et al. Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA. 2017;317:1642–1651.

23. Reed GW, Horr S, Young L, Clevenger J, Malik U, Ellis SG, et al. Associations beteen cardiac troponin, mechanism of myocardial injury, and long-term mortality after noncardiac vascular surgery. J Am Heart Assoc. 2017;6:e005672.

24. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33:2551–2567.

25. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267–315.

26. Duvall WL, Sealove B, Pungoti C, Katz D, Moreno P, Kim M. Angiographic investigation of the pathophysiology of perioperative myocardial infarction. Catheter Cardiovasc Interv. 2012;80:768–776.

27. Hanson I, Kahn J, Dixon S, Goldstein J. Angiographic and clinical characteristics of type 1 versus type 2 perioperative myocardial infarction. Catheter Cardiovasc Interv. 2013;82: 622–628.

28. Dawood MM, Gutpa DK, Southern J, Walia A, Atkinson JB, Eagle KA. Pathology of fatal perioperative myocardial infarction: implications regarding pathophysiology and prevention. Int J Cardiol. 1996;57:37–44.

29. Gualandro DM, Campos CA, Calderaro D, Yu PC, Marques AC, Pastana AF, et al. Coronary plaque rupture in patients with myocardial infarction after noncardiac surgery: frequent and dangerous. Atherosclerosis. 2012;222:191–195.

30. Smilowitz NR, Weiss MC, Mauricio R, Mahajan AM, Dugan KE, Devanabanda A, et al. Provoking conditions, management and outcomes of type 2 myocardial infarction and myocardial necrosis. Int J Cardiol. 2016;218:196–201.

31. Cediel G, Gonzalez-Del-Hoyo M, Carrasquer A, Sanchez R, Boque C, Bardaji A. Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury. Heart. 2016;103:616–622.

32. Smilowitz NR, Naoulou B, Sedlis SP. Diagnosis and management of type II myocardial infarction: increased demand for a limited supply of evidence. Curr Atheroscler Rep. 2015;17:478, doi:10.1002//311883-0140478-1.

33. Baron JM, Lewandrowski EL, Januzzi JL, Bajwa EK, Thompson BT, Lewandrowski KB. Measurement of high-sensitivity troponin T in noncardiac medical intensive care unit patients. Correlation to mortality and length of stay. Am J Clin Pathol. 2014;141:488–493.

34. Smilowitz NR, Gupta N, Guo Y, Bangalore B. Comparison of Outcomes of Patients With Sepsis With Versus Without Acute Myocardial Infarction and Comparison of Invasive Versus Noninvasive Management of the Patients With Infarction. Am J Cardiol. 2016;117:1065–1071.

35. Libby P, Ridker PM, Maseri A. Inflammation and Atherosclerosis. 2002;105:1135–1143.

36. Libby P, Tabas I, Fredman G, Fisher EA. Inflammation and its resolution as determinants of acute coronary syndromes. Circ Res. 2014;114:1867–1879.

37. Michail M, Serruys PW, Stettler R, Crake T, Torii R, Tenekecioglu E, et al. Intravascular multimodality imaging: feasibility and role in the evaluation of coronary plaque pathology. Eur Heart J Cardiovasc Imaging. 2017;18:613–620.

38. Cesari M, Penninx BW, Newman AB, Kritchevsky SB, Nicklas BJ, Sutton-Tyrrell K, et al. Inflammatory markers and onset of cardiovascular events: results from the Health ABC study. Circulation. 2003;108:2317–2322.

39. Crea F, Libby P. Acute coronary syndroms. The way forward from mechanisms to precision treatment. Circulation. 2017;136:1155–1166.

40. Dutta P, Courties G, Wei Y, Leuschner F, Gorbatov R, Robbins CS, et al. Myocardial infarction accelerates atherosclerosis. Nature. 2012;487:325–329.

41. Joshi NV, Toor I, Shah AS, Carruthers K, Vesey AT, Alam SR, et al. Systemic Atherosclerotic Inflammation Following Acute Myocardial Infarction: Myocardial Infarction Begets Myocardial Infarction. J Am Heart Assoc. 2015;4:e001956.

42. Han Y, Jing J, Tu S, Tian F, Xue H, Chen W, et al. ST elevation acute myocardial infarction accelerates non-culprit coronary lesion atherosclerosis. Int J Cardiovasc Imaging. 2014;30:253–261.

43. Bergh C, Fall K, Udumyan R, Sjöqvist H, Frobert O, Montgomery S. Severe infections and subsequent delayed cardiovascular disease. European journal of preventive Cardiology. 2017;0:1–9.

44. Sheth T, Chan M, Butler C, Chow B, Tandon V, Nagele P, Mitha A, Mrkobrada M., et al. BMJ. 2015;350:h1907.

45. Grobben RB, van Waes JAR, Leiner T, Peelen LM, de Borst GJ, Vogely HC, Grobbee DE, Doevendans PA, van Klei WA, Nathoe HM, on behalf of the CHASE Investigators. Unexpected Cardiac Computed Tomography Findings in Patients With Postoperative Myocardial Injury. Anesth Analg. 2017 Nov 1. doi: 10.1213/ANE.0000000000002580. [Epub ahead of print].

46. Ford I, Shah AS, Zhang R, McAllister DA, Strachan FE, Caslake M, et al. High sensitivity cardiac troponin, statin therapy, and risk of coronary heart disease. 2016;68:2719–2728.

47. Singh P, Emami H, Subramanian S, Maurovich-Horvat P, Marincheva-Savcheva G, Medina HM, et al. Coronary Plaque Morphology and the Anti-Inflammatory Impact of Atorvastatin: A Multicenter 18F-Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Study. Circ Cardiovasc Imaging. 2016;9:e004195.

48. Berwanger O, Le Manach Y, Suzumura EA, Biccard B, Srinathan SK, Szczeklik W, et al. Association between pre-operative statin use and major cardiovascular complications among patients undergoing non-cardiac surgery: the VISION study. Eur Heart J. 2016;37:p177–185.

49. Ridker PM, Everett BM, Thuren T, McFadyen SG, Chang WH, Ballantyne C, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377:1119–1131.

50. Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol. 2017;33:17–32.

Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#