Potential risks of non-cardiac peri-operative myocardial infarction/injury

Elderly surgical patients often manifest a variety of chronic comorbidities, including cardiovascular comorbidities, and thus the risk of peri-operative myocardial injury/infarction (PMI) is high. Surgical trauma and anaesthesia induce activation of the sympathetic nervous system, acute systemic inflammatory reactions, hypercoagulability condition, and a catabolic state. These factors can result in a variety of cardiac complications including an increase of myocardial oxygen demand, which is one of the main causes of PMI.1,2 Thus, not surprisingly, it has been shown that PMI, defined as increased high-sensitivity cardiac troponin (hs-cTn), is a common complication after non-cardiac surgery. It occurred in one of seven patients older than 65 years of age or having pre-existing cardiac atherosclerotic disease (CAD) and was associated with a substantial 1-year mortality of 22% in a previous large study conducted in Basel.3As shown in this issue of the European Heart Journal, this centre together with two additional institutions now has performed an even larger prospective investigation of non-cardiac surgical patients applying similar inclusion and endpoint criteria to those above which showed a mortality within 1 year of 10.5%.4This long-Term mortality is about half that of the previous study which may reflect heterogeneous patient compositions and/or improved post-operative care in more contemporary post-operative settings.