American Heart Association review finds that many noncardiac surgeries can lead to heart damage
Each year, across the world, 200 million adults undergo noncardiac surgery. Of these a staggering 1 million will die within a month [1]. A review by the American Heart Association looked at a number of different studies and found that these noncardiac surgeries may be causing asymptomatic heart damage[2].
What’s Happening?
Say you believe that you’re experiencing a heart attack and arrive at the hospital complaining of chest pain. The doctors first take an EKG to record the electrical signal from the heart. If this looks normal they move on to a blood test. What they are looking for here is troponin. This is a muscle breakdown protein that–when present in your blood–indicates damage to the muscles of your heart. This confirms what you suspected. You are having a heart attack.
How does this relate?
But, that’s a heart attack. What does it have to do with noncardiac surgeries? The American Heart Association has released a statement about the risks of cardiac complications after noncardiac surgery. This newly identified diagnosis is called myocardial injury after noncardiac surgery (MINS), and is indicated by the increase in troponin levels without other heart attack symptoms. Their review of various studies found that an increase in troponin levels in the three days post surgery can indicate an increase in a patient’s risk of death. The highest instances of MINS occurred in Emergency, Vascular, Orthopedic, Thoracic, and General Surgeries[2].
MINS after orthopedic surgery
Of the people who underwent Orthopedic Surgery, about 12% were found to have MINS. This is a big deal as those who have MINS are 9 times more likely to die within 30 days of their surgery [3]. Studies show that MINS can be caused by many different things that occur during surgery like very low or high heat rate, low or high blood pressure, or even a severe inflammatory response caused by the extensive tissue damage from surgery. You would be more at risk of developing MINS if you are Elderly, Male, and Non active or if you have:
- High blood pressure
- Diabetes
- Prior heart disease
- Peripheral artery disease
- Heart valve disease (i.e. mitral valve prolapse)
- Chronic heart failure or kidney disease
With this newly discovered risk it is more important than ever to consider if surgery is the right option for you and to try exhausting all non surgical options first [2].
Non-surgical treatment options at Regenexx
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References
[1] Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA. 2012;307(21):2295–2304. doi:10.1001/jama.2012.5502
[2] Ruetzler K, Smilowitz NR, Berger JS, Devereaux PJ, Maron BA, Newby LK, de Jesus Perez V, Sessler DI, Wijeysundera DN. Diagnosis and Management of Patients With Myocardial Injury After Noncardiac Surgery: A Scientific Statement From the American Heart Association. Circulation. 2021 Nov 9;144(19):e287-e305. doi: 10.1161/CIR.0000000000001024. Epub 2021 Oct 4. PMID: 34601955.
[3] Thomas, Sabu MD, MSc1,2,a; Borges, Flavia MD, PhD2; Bhandari, Mohit MD, PhD2; De Beer, Justin MD2; Urrútia Cuchí, Gerard MD3; Adili, Anthony MD2; Winemaker, Mitchell MD2; Avram, Victoria MD2; Chan, Matthew T.V. MD4; Lamas, Claudia MD, PhD5; Cruz, Patricia MD5; Aguilera, Xavier MD3; Garutti, Ignacio MD5; Alonso-Coello, Pablo MD3; Villar, Juan Carlos MD6; Jacka, Michael MD, MSc7; Wang, C.Y. MD8; Berwanger, Otavio MD2; Chow, Clara MD, PhD9; Srinathan, Sadeesh MD10; Pettit, Shirley RN2; Heels-Ansdell, Dianne PhD2; Rubery, Paul MD1; Devereaux, P.J. MD, PhD2, on behalf of the VISION Investigators* Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery, The Journal of Bone and Joint Surgery: May 20, 2020 – Volume 102 – Issue 10 – p 880-888
doi: 10.2106/JBJS.18.01305
See abstract here
