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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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1 University of Basel, Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642)
2 University of Basel, Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642); Universidade de São Paulo, Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, São Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722)
3 University of Basel, Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642); University of Basel, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642)
4 University Hospital Düsseldorf, Department of Anaesthesiology, Düsseldorf, Germany (GRID:grid.14778.3d) (ISNI:0000 0000 8922 7789); University Basel, Department of Anaesthesiology, University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642)
5 University Basel, Department of Anaesthesiology, University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642)
6 University of Basel, Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642); Kantonsspital St. Gallen, Department of Anaesthesiology, St. Gallen, Switzerland (GRID:grid.413349.8) (ISNI:0000 0001 2294 4705)
7 Kantonsspital Aarau, Department of Anaesthesiology, Aarau, Switzerland (GRID:grid.413357.7) (ISNI:0000 0000 8704 3732)
8 Universidade de São Paulo, Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, São Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722)
9 University of Basel, Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642)
10 University of Basel, Department of Spinal Surgery, University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642)
11 University Hospital Basel, University of Basel, Department Orthopedic Surgery, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642)
12 University of Basel, Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642); University Basel, Department of Anaesthesiology, University Hospital Basel, Basel, Switzerland (GRID:grid.6612.3) (ISNI:0000 0004 1937 0642)
13 University Hospital Basel, Department of Laboratory Medicine, Basel, Switzerland (GRID:grid.410567.1)
14 Kantonsspital Aarau, Department of Laboratory Medicine, Aarau, Switzerland (GRID:grid.413357.7) (ISNI:0000 0000 8704 3732)