Implementing screening for myocardial injury in non-cardiac surgery: perspectives of an ad-hoc interdisciplinary expert group

Abstract

Objectives. Perioperative myocardial injury (PMI) is increasingly recognised as an important complication of non-cardiac surgery, with often clinically silent presentation, but detrimental prognosis. Active screening for PMI, involving the detection of dynamic and elevated levels of cardiac troponin, has recently been advocated by an increasing number of guidelines; however, active PMI screening has not been reflected in clinical practice. Design. As consensus on a common screening and management pathway is lacking, we synthesise the current evidence to provide suggestions on the selection of patients for screening, organisation of a screening program, and a potential management pathway, building upon a recently published perioperative screening algorithm. Results. Screening should be performed using high-sensitivity assays both preoperatively and postoperatively (postoperative Days 1 and 2) in patients at high-risk of experiencing perioperative complications. Conclusion. This expert opinion piece by an interdisciplinary group of predominantly Norwegian clinicians aims to assist healthcare professionals planning to implement guideline-recommended PMI screening at a local level in order to improve patient outcomes following non-cardiac surgery.

Keywords:

• Perioperative screening
• myocardial injury
• myocardial infarction
• cardiac troponin
• PMI

Disclosure statement

All authors participated in an advisory board organised by Roche Diagnostics (chair: DA). DA has received honoraria from Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS/Pfizer, MSD, Novartis, Roche-Diagnostics, Sanofi, and Vifor, outside the submitted work. He has also received grants to the institution from BMS/Pfizer, Roche-Diagnostics, and Medtronics, outside the submitted work. LAR has received honorarium as a member of a scientific advisory board from Ferring Pharmaceutical, Roche Diagnostics, and from an expert input meeting hosted by MDS, Norway. IJ reports research grants from the European Society of Anaesthesiology and Intensive Care (ESAIC) and Roche, speaker honoraria from Orion and is chair of the Perioperative Medicine and Management (PoMM) program from the Scandinavian Society of Anaesthesia and Intensive Care (SSAI). KMA has served on advisory boards for Roche Diagnostics and received personal fees from Siemens Healthineers. RW reports no conflicts of interest. MM reports no conflicts of interest. DMG reports grants from the Swiss Heart Foundation and consulting fees from Roche. TO has received speaker fees, consulting honoraria, and research funding via Akershus University Hospital from manufacturers of cardiac troponin assays (Roche Diagnostics, Abbott Diagnostics, Siemens Healthineers).

Additional information

Funding

Editorial support was provided by Samantha Blakemore of inScience Communications, Springer Healthcare Ltd, Chester, UK, and was funded by Roche Diagnostics who initiated and sponsored the advisory board meeting where discussions on this topic were held. While Roche Diagnostics provided funding for the article, they were not involved in the development or review of the manuscript.