Management of Patients with Myocardial Injury After Noncardiac Surgery: A Retrospective Chart Review

Background: Myocardial injury after noncardiac surgery (MINS) is associated with an increased incidence of cardiac morbidity and mortality. Little is known about how these patients are managed. Methods: We performed a single-centre retrospective chart review of patients referred to a postoperative clinic with the diagnosis of MINS. Patients were included if they attended the clinic at least once between September 2018 and December 2019. We extracted preoperative, in-hospital, and postdischarge data on cardiac investigations and medication use. Results: Of the 152 patients with MINS who were included, 34% had a history of coronary disease before MINS. The median peak high-sensitivity troponin I (hsTnI) level was 122 ng/L (interquartile range, 51-259), and 78% had no associated ischemic symptoms or electrocardiographic changes. Patients underwent echocardiography and nuclear stress imaging in 87% and 30% of cases, respectively. Of those who had cardiac investigations performed and no prior history of coronary artery disease, 23% (19 of 84) had ≥ 1 regional wall-motion abnormality on echocardiogram, and 39% (13 of 34) had evidence of ischemia on nuclear stress imaging. More patients were prescribed an antithrombotic and lipid-lowering drug at discharge (79%) and at their final clinic visit (86%), compared to the number before surgery (30%). A total of 57% of patients had changes made to ≥ 1 cardiovascular medication during clinic follow-up. Conclusions: Patients with MINS followed in a postoperative clinic frequently had abnormal cardiac investigations and received medical optimization. Our findings suggest that postoperative clinics may represent an opportunity for risk mitigation after MINS, a possibility that deserves further evaluation.