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Long-term outcomes of time-dependent phenotypes of perioperative myocardial injury☆

Fält, Mikael ; Åhman, Rasmus ; Hammarskjöld, Fredrik ; Lyckner, Sara ; Jawad, Monir LU orcid ; Andersson, Ulrika LU ; Fredrikson, Mats ; Sperber, Jesper ; Elander, Louise and De Geer, Lina , et al. (2025) In BJA Open 14.
Abstract

Background: Perioperative myocardial injury (PMI) is associated with increased short-term major adverse cardio- and cerebrovascular events (MACCE) and mortality. We evaluated how different phenotypes of PMI based on timing of injury impact long-term MACCE and mortality among patients undergoing major noncardiac surgery (NCS). Methods: A prospective, observational study was carried out in 1290 patients aged ≥50 yr undergoing major noncardiac surgery. High-sensitivity cardiac troponin T (hs-cTnT) was measured before surgery and up to 3 days after surgery. Patients were classified into four groups: (1) no hs-cTnT elevation, (2) isolated preoperative hs-cTnT increases, (3) normal preoperative hs-cTnT with perioperative elevation, and (4)... (More)

Background: Perioperative myocardial injury (PMI) is associated with increased short-term major adverse cardio- and cerebrovascular events (MACCE) and mortality. We evaluated how different phenotypes of PMI based on timing of injury impact long-term MACCE and mortality among patients undergoing major noncardiac surgery (NCS). Methods: A prospective, observational study was carried out in 1290 patients aged ≥50 yr undergoing major noncardiac surgery. High-sensitivity cardiac troponin T (hs-cTnT) was measured before surgery and up to 3 days after surgery. Patients were classified into four groups: (1) no hs-cTnT elevation, (2) isolated preoperative hs-cTnT increases, (3) normal preoperative hs-cTnT with perioperative elevation, and (4) increased preoperative hs-cTnT with perioperative elevation. The main outcomes were MACCE and mortality up to 3 yr after operation. Results: At 3-yr follow-up, MACCE had occurred in 17.1%, 37.9%, 45.2%, and 50.7% and mortality was 21.4%, 30.3%, 30.1%, and 33.8% in groups 1–4, respectively. All PMI phenotypes were independently associated with MACCE. Patients with ‘normal preoperative hs-cTnT with perioperative elevation’ appeared to have the highest risk. In this phenotype, the risk was greatest at 30 days (adjusted odds ratio, 4.5; 95% confidence interval, 2.3–8.8) and persisted over 3 yr (adjusted odds ratio, 3.5; 95% confidence interval, 2.0–5.9). PMI was associated with increased mortality, but the relationship was not sustained after multivariable adjustment. Conclusions: Increased hs-cTnT based on timing identifies prognostically important subgroups. Perioperative increases, regardless of preoperative levels, are associated with a high risk of MACCE that is sustained up to 3 yr after surgery. This supports the use of time-based PMI phenotypes for prognostic enrichment studies to mitigate the risk of MACCE. Clinical trial registration: NCT03436238.

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Contribution to journal
publication status
published
subject
keywords
biomarker, cardiac troponins, high-sensitivity cardiac troponin T, MACE, major adverse cardiovascular events, MINS, myocardial injury, perioperative
in
BJA Open
volume
14
article number
100422
publisher
Elsevier
external identifiers
  • scopus:105007062434
  • pmid:40529719
DOI
10.1016/j.bjao.2025.100422
language
English
LU publication?
yes
id
1656d4fd-14fd-4fae-bbac-04644d6efa1e
date added to LUP
2025-07-29 12:14:32
date last changed
2025-07-30 03:00:03
@article{1656d4fd-14fd-4fae-bbac-04644d6efa1e,
  abstract     = {{<p>Background: Perioperative myocardial injury (PMI) is associated with increased short-term major adverse cardio- and cerebrovascular events (MACCE) and mortality. We evaluated how different phenotypes of PMI based on timing of injury impact long-term MACCE and mortality among patients undergoing major noncardiac surgery (NCS). Methods: A prospective, observational study was carried out in 1290 patients aged ≥50 yr undergoing major noncardiac surgery. High-sensitivity cardiac troponin T (hs-cTnT) was measured before surgery and up to 3 days after surgery. Patients were classified into four groups: (1) no hs-cTnT elevation, (2) isolated preoperative hs-cTnT increases, (3) normal preoperative hs-cTnT with perioperative elevation, and (4) increased preoperative hs-cTnT with perioperative elevation. The main outcomes were MACCE and mortality up to 3 yr after operation. Results: At 3-yr follow-up, MACCE had occurred in 17.1%, 37.9%, 45.2%, and 50.7% and mortality was 21.4%, 30.3%, 30.1%, and 33.8% in groups 1–4, respectively. All PMI phenotypes were independently associated with MACCE. Patients with ‘normal preoperative hs-cTnT with perioperative elevation’ appeared to have the highest risk. In this phenotype, the risk was greatest at 30 days (adjusted odds ratio, 4.5; 95% confidence interval, 2.3–8.8) and persisted over 3 yr (adjusted odds ratio, 3.5; 95% confidence interval, 2.0–5.9). PMI was associated with increased mortality, but the relationship was not sustained after multivariable adjustment. Conclusions: Increased hs-cTnT based on timing identifies prognostically important subgroups. Perioperative increases, regardless of preoperative levels, are associated with a high risk of MACCE that is sustained up to 3 yr after surgery. This supports the use of time-based PMI phenotypes for prognostic enrichment studies to mitigate the risk of MACCE. Clinical trial registration: NCT03436238.</p>}},
  author       = {{Fält, Mikael and Åhman, Rasmus and Hammarskjöld, Fredrik and Lyckner, Sara and Jawad, Monir and Andersson, Ulrika and Fredrikson, Mats and Sperber, Jesper and Elander, Louise and De Geer, Lina and Didriksson, Helén and Jonsson, Carina and Andersson, Henrik and Chew, Michelle S.}},
  keywords     = {{biomarker; cardiac troponins; high-sensitivity cardiac troponin T; MACE; major adverse cardiovascular events; MINS; myocardial injury; perioperative}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{BJA Open}},
  title        = {{Long-term outcomes of time-dependent phenotypes of perioperative myocardial injury<sup>☆</sup>}},
  url          = {{http://dx.doi.org/10.1016/j.bjao.2025.100422}},
  doi          = {{10.1016/j.bjao.2025.100422}},
  volume       = {{14}},
  year         = {{2025}},
}