Postoperative myocardial injury phenotypes and self-reported disability in patients undergoing noncardiac surgery: a multicentre observational study

Lisette M Vernooij; Judith A R van Waes; Remco B Grobben; Felix van Lier; Simon Feng; Matthew Machina; Michael McKenny; Hendrik M Nathoe; Duminda N Wijeysundera; Wilton A van Klei; W Scott Beattie

doi:10.1016/j.bja.2023.10.012

Postoperative myocardial injury phenotypes and self-reported disability in patients undergoing noncardiac surgery: a multicentre observational study

Br J Anaesth. 2024 Jan;132(1):35-44. doi: 10.1016/j.bja.2023.10.012. Epub 2023 Dec 5.

Authors

Affiliations

¹ Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands; Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: [email protected].
² Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
³ Department of Cardiology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
⁴ Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵ Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.
⁷ Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada; Department of Anesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland.
⁸ Department of Anesthesia, St. Michael's Hospital - Unity Health Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands; Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada.
¹⁰ Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada.

PMID: 38057252
DOI: 10.1016/j.bja.2023.10.012

Abstract

Background: Postoperative myocardial injury (PMI) comprises a spectrum of mechanisms resulting in troponin release. The impact of different PMI phenotypes on postoperative disability remains unknown.

Methods: This was a multicentre prospective cohort study including patients aged ≥50 yr undergoing elective major noncardiac surgery. Patients were stratified in five groups based on the occurrence of PMI and clinical information on postoperative adverse events: PMI classified as myocardial infarction (MI; according to fourth definition), PMI plus adverse event other than MI, clinically silent PMI (PMI without adverse events), adverse events without PMI, and neither PMI nor an adverse event (reference). The primary endpoint was 6-month self-reported disability (assessed by WHO Disability Assessment Schedule 2.0 [WHODAS]). Disability-free survival was defined as WHODAS ≤16%.

Results: We included 888 patients of mean age 69 (range 53-91) yr, of which 356 (40%) were women; 151 (17%) patients experienced PMI, and 625 (71%) experienced 6-month disability-free survival. Patients with PMI, regardless of its phenotype, had higher preoperative disability scores than patients without PMI (difference in WHODAS; β: 3.3, 95% confidence interval [CI]: 0.5-6.2), but scores remained stable after surgery (β: 1.2, 95% CI: -3.2-5.6). Before surgery, patients with MI (n=36, 4%) were more disabled compared with patients without PMI and no adverse events (β: 5.5, 95% CI: 0.3-10.8). At 6 months, patients with MI and patients without PMI but with adverse events worsened in disability score (β: 11.2, 95% CI: 2.3-20.2; β: 8.1, 95% CI: 3.0-13.2, respectively). Patients with clinically silent PMI did not change in disability score at 6 months (β: 1.39, 95% CI: -4.50-7.29, P=0.642).

Conclusions: Although patients with postoperative myocardial injury had higher preoperative self-reported disability, disability scores did not change at 6 months after surgery. However, patients experiencing myocardial infarction worsened in disability score after surgery.

Keywords: disability; myocardial infarction; noncardiac surgery; postoperative myocardial injury; troponins.

Publication types

Observational Study
Multicenter Study

MeSH terms

Aged
Female
Heart Injuries*
Humans
Male
Myocardial Infarction* / epidemiology
Phenotype
Postoperative Complications / epidemiology
Prospective Studies
Risk Factors
Self Report