European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery

Author:

Gaudino Mario1ORCID,Flather Marcus23ORCID,Capodanno Davide4ORCID,Milojevic Milan5ORCID,Bhatt Deepak L6,Biondi Zoccai Giuseppe78,Boden William E9,Devereaux P J101112,Doenst Torsten13,Farkouh Michael14,Freemantle Nicholas15,Fremes Stephen161718ORCID,Puskas John19,Landoni Giovanni2021,Lawton Jennifer22,Myers Patrick O23,Redfors Björn2425,Sandner Sigrid26ORCID

Affiliation:

1. Department of Cardiothoracic Surgery, Weill Cornell Medicine , New York, NY, USA

2. Norwich Medical School, University of East Anglia , Norwich, UK

3. Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK

4. Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico-San Marco”, University of Catania , Catania, Italy

5. Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute , Belgrade, Serbia

6. Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai , New York, NY, USA

7. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome , Latina, Italy

8. Mediterranea Cardiocentro , Naples, Italy

9. VA New England Healthcare System, Boston University School of Medicine , Boston, MA, USA

10. Department of Medicine, McMaster University , Hamilton, ON, Canada

11. Department of Health Research Methods, Evidence, and Impact, McMaster University , Hamilton, ON, Canada

12. Population Health Research Institute , Hamilton, ON, Canada

13. Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University , Jena, Germany

14. Academic Affairs, Cedars-Sinai Health System, Los Angeles, CA, USA

15. Institute of Clinical Trials and Methodology, University College London , London, UK

16. Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, ON, Canada

17. Division of Cardiac Surgery, University of Toronto , Toronto, ON, Canada

18. Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto, ON, Canada

19. Department of Cardiovascular Surgery, Mount Sinai Morningside , New York, NY, USA

20. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute , Milan, Italy

21. Faculty of Medicine, Vita-Salute San Raffaele University , Milan, Italy

22. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University , Baltimore, MD, USA

23. Department of Cardiac Surgery, CHUV-Center Hospitalier Universitaire Vaudois , Lausanne, Switzerland

24. Cardiovascular Research Foundation , New York, NY, USA

25. Department of Cardiology, Sahlgrenska University Hospital , Gothenburg, Sweden

26. Department of Cardiac Surgery, Medical University of Vienna , Vienna, Austria

Abstract

Abstract Cardiac surgery may lead to myocardial damage and release of cardiac biomarkers through various mechanisms such as cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest and ischaemia caused by coronary or graft occlusion. Defining perioperative myocardial infarction (PMI) after cardiac surgery presents challenges, and the association between the current PMI definitions and postoperative outcomes remains uncertain. To address these challenges, the European Association of Cardio-Thoracic Surgery (EACTS) facilitated collaboration among a multidisciplinary group to evaluate the existing evidence on the mechanisms, diagnosis and prognostic implications of PMI after cardiac surgery. The review found that the postoperative troponin value thresholds associated with an increased risk of mortality are markedly higher than those proposed by all the current definitions of PMI. Additionally, it was found that large postoperative increases in cardiac biomarkers are prognostically relevant even in absence of additional supportive signs of ischaemia. A new algorithm for PMI detection after cardiac surgery was also proposed, and a consensus was reached within the group that establishing a prognostically relevant definition of PMI is critically needed in the cardiovascular field and that PMI should be included in the primary composite outcome of coronary intervention trials.

Funder

European Association for Cardio-Thoracic Surgery

Publisher

Oxford University Press (OUP)

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