Perioperative myocardial screening

Perioperative myocardial screening
Expert consensus on perioperative myocardial injury screening in non-cardiac surgery

Dr. Christian Puelacher MD, Phd. from University Hospital of Basel and Cardiovascular Research Institute Basel shares his research findings in the field of perioperative cardiology focusing on perioperative myocardial injury (PMI) after non-cardiac surgery.

PMI is associated with a mortality of 10% within 30 days after non-surgery. Being largely asymptomatic, new guidelines to recommend screening in high-risk patients are emerging. The research aimed to summarize key findings and provide an example of a successful implementation of a PMI screening and care program to improve patient outcomes. As a result, this could also contribute to the development of standardized programs aimed at systematic screening pathways for myocardial injury following non cardiac surgery.

A few factors were identified that would characterize the success of a PMI screening program including an interdisciplinary approach with anaesthesiologists, cardiologists and surgeons. The screening would be aimed at patients with an elevated risk of cardiovascular disease. The design reliably differentiates between acute vs. chronic myocardial injury and proper pathways and response systems should provide guidance for follow-up diagnostics and therapy.

There is evidence that Troponin, specifically high sensitivity troponin T due to its high specificity for the myocardium, can be used in combination with pre-operative baseline and two post-operative measurements to reliably detect acute vs chronic injuries. 

For further details about using Troponin in acute perioperative myocardial injury screening programs and on what to do with a positive screening result, Dr. Puelacher’s video above details how to determine exact etiology of the spectrum of myocardial injury and discusses possible therapies that research has shown to be beneficial.

Key facts
  • Dr Puelacher MD, Phd. shares his research insights within the field of perioperative cardiology, emphasizing the need for perioperative myocardial injury (PMI) screening and care programs to improve perioperative care and outcomes following non cardiac surgery.
  • For screening programs his research shows the following key success factors:
    • The program is an interdisciplinary effort, a collaboration of surgeons, anaesthesiologists and cardiologists.
    • The program is aimed at patients with an elevated risk of cardiovascular disease and as PMI reflects a spectrum of disease, management is tailored to the individual patient.
    • The screening design differentiates between PMI that is acute and therefore actionable in contrast to chronic myocardial injury.
  • Troponin, specifically high sensitivity troponin, can be a key component of such screening programs.

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