Research

Incidence of myocardial injury after non-cardiac surgery: Experience at Groote Schuur Hospital, Cape Town, South Africa

E Coetzee, B M Biccard, R A Dyer, N D Meyersfeld, C Chishala, B M Mayosi

Abstract


Background. Myocardial injury after non-cardiac surgery (MINS) is a newly recognised entity identified as an independent risk factor associated with increased 30-day all-cause mortality. MINS increases the risk of death in the perioperative period by ~10-fold. More than 80% of patients with MINS are asymptomatic, so the majority of diagnoses are missed. Awareness of MINS is therefore important for perioperative physicians.

Objectives. To investigate the incidence of MINS after elective elevated-risk non-cardiac surgery at Groote Schuur Hospital, Cape Town, South Africa (SA).

Methods. Patients aged ≥45 years undergoing elective elevated-risk non-cardiac surgery were enrolled via convenience sampling. The new fifth-generation high-sensitivity cardiac troponin T blood test was used postoperatively to identify MINS. Preoperative troponin levels were not measured.

Results. Among 244 patients included in the study, the incidence of MINS was 4.9% (95% confidence interval (CI) 2.8 - 8.5), which was not significantly different from that in a major international prospective observational study (VISION) (8.0% (95% CI 7.5 - 8.4)); p=0.080.

Conclusions. Our SA cohort had a lower cardiovascular risk profile but a similar incidence of MINS to that described in international literature. The impact of MINS on morbidity and mortality is therefore likely to be proportionally higher in SA than in published international studies. The limited sample size and lower event rate weaken our conclusions. Larger studies are required to establish patient and surgical risk factors for MINS, allowing for revision of cardiovascular risk prediction models in SA.

 


Authors' affiliations

E Coetzee, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

B M Biccard, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

R A Dyer, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

N D Meyersfeld, Private practice, Southern Anaesthetic Associates, Cape Town, South Africa

C Chishala, Department of Cardiology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

B M Mayosi, Dean’s Office, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

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Keywords

Anaesthesia; Perioperative medicine; Myocardial injury; Non-cardiac surgery; MINS; Troponin elevation; Incidence study; Cardiovascular risk; South Africa; Groote Schuur Hospital

Cite this article

South African Medical Journal 2018;108(5):408-412. DOI:10.7196/SAMJ.2018.v108i5.12784

Article History

Date submitted: 2018-04-25
Date published: 2018-04-25

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