Even Non-Heart Surgery May Harm Your Heart

From Drugs.com - December 4, 2017

Even Non-Heart Surgery May Harm Your Heart

MONDAY, Dec. 4, 2017 -- Older adults commonly suffer damage to heart cells during various types of surgery -- even non-heart-related surgeries -- and it can significantly raise their risk of dying from the procedure, a new study finds.

The research looked at a phenomenon called perioperative myocardial injury, or PMI. It refers to subtler heart damage that can happen during or soon after any type of surgery.

Older patients and those who already have heart disease are at increased risk.

However, the condition is easily missed because most of the affected patients have no chest pain or other symptoms, according to Dr. Christian Puelacher, the first author on the new study. He's a clinical researcher at Cardiovascular Research Institute Basel in Switzerland.

Puelacher's team found that PMI may happen more often than doctors have typically thought: Of more than 2,000 high-risk patients they screened, 1 in 7 developed PMI after a non-cardiac surgery, the study found.

"This suggests we have underestimated the number of myocardial [heart] injuries that occur during non-cardiac surgery," said Dr. Alistair Phillips, co-chair of the surgeons' section leadership council for the American College of Cardiology.

The cases were found because all of the patients -- treated at the University Hospital Basel in Switzerland -- were screened for PMI with a newer blood test: a so-called "high sensitivity" troponin test, which detects elevations in the heart protein troponin.

When troponin levels rise, it's a sign of heart damage, Phillips explained.

High-sensitivity troponin tests have been used in Europe and elsewhere for several years, but have only recently become available in the United States. The U.S. Food and Drug Administration approved the first such test earlier this year.

Phillips, who was not involved with the study, said that as such testing comes into wider use, doctors will be able to better manage patients who develop PMI.

The findings are based on more than 2,000 patients who underwent non-cardiac procedures ranging from knee and prostate surgeries to hip replacements and gallbladder removal.

All of the patients had their troponin levels measured before and after surgery because they were considered high-risk for PMI: They were either older than 65, or had a history of heart disease, stroke or peripheral artery disease (clogged leg arteries).

Overall, 1 in 7 developed PMI. And those patients had a six times higher death rate in the 30 days after surgery: 9 percent died, versus only 1.5 percent of patients without PMI.

Most often, the study found, patients had no telltale signs of heart damage. Only 6 percent had chest pain, while 18 percent had any symptoms to signal that blood and oxygen flow to the heart was being impaired.

According to Puelacher, the findings offer some "first hints" that systematic screening for PMI can benefit patients.


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