Management of Postoperative Myocardial Injury After Non-cardiac Surgery in Patients Aged ≥ 80 Years: Our 10 Years' Experience

Linggen Gao; Lei Chen; Bin Wang; Jing He; Chaoyang Liu; Rong Wang; Rui Cheng

doi:10.3389/fcvm.2022.869243

Management of Postoperative Myocardial Injury After Non-cardiac Surgery in Patients Aged ≥ 80 Years: Our 10 Years' Experience

Front Cardiovasc Med. 2022 Apr 13:9:869243. doi: 10.3389/fcvm.2022.869243. eCollection 2022.

Authors

Linggen Gao¹, Lei Chen², Bin Wang¹, Jing He¹, Chaoyang Liu¹, Rong Wang¹, Rui Cheng¹

Affiliations

¹ Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China.
² Department of Thoracic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, China.

Abstract

Background: Postoperative myocardial injury (PMI) is associated with short- and long-term mortality. The incidence of PMI in very old patients is currently unknown. There is currently neither known effective prophylaxis nor a uniform strategy for the elderly with PMI.

Objective: To share our 10 years of experience in the comprehensive management of PMI after non-cardiac surgery in patients aged ≥ 80 years.

Methods: In this case series, we retrospectively collected and assessed the 2,984 cases aged ≥ 80 years who accepted non-cardiac surgery from 2011 to 2021 at the second Medical Center, Chinese PLA General Hospital. The incidence, risk factors, management strategy, and prognosis of surgical patients with PMI were analyzed.

Results: A total of 2,984 patients met our inclusion criteria. The overall incidence of PMI was 14%. In multivariable analysis, coronary artery disease, chronic heart failure, and hypotension were independently associated with the development of PMI. The patients with PMI were at a higher risk of death (OR, 2.69; 95% CI, 1.78-3.65). They were more likely to have received low molecular heparin, anti-plantlet therapy, beta-blocker, early coronary angiography, and statin than patients without PMI. The 30-day (0.96% vs. 0.35%; OR 3.46; 95% CI, 1.49-7.98; P < 0.001) and 1-year mortality (5.37% vs. 2.60%; OR 2.35; 95% CI, 1.12-6.53; P < 0.001) was significantly higher in patients with PMI compared with those without PMI.

Conclusions: The incidence of PMI in very old patients was high. The PMI is associated with an increased risk of 30 days and 1-year mortality. These patients can benefit from intensification of assessment and individualized care of multi-morbidities during the perioperative period. Especially cardiovascular medical treatments, such as antiplatelet, anticoagulation, β-blockers, and statins are very important for patients with PMI.

Keywords: comanagement care model; management strategy; non-cardiac surgery; postoperative myocardial injury; prognosis.