Peri-operative myocardial infarction/injury after non-cardiac surgery: association between cardiologist evaluation and outcomes

BACKGROUND AND AIMS: Peri-operative myocardial infarction/injury (PMI) is a common cardiac complication following non-cardiac surgery. It remains unclear whether involvement of cardiologists in the management of patients developing PMI improves outcomes. METHODS: This multicentre, prospective study included high-risk patients undergoing non-cardiac surgery, eligible for the institutional PMI active surveillance and response programme. Due to staffing constraints, cardiologist evaluation of patients with PMI was inconsistently available on weekends, on public holidays, or when care for more urgent patients had to be prioritized, allowing a comparison between patients receiving cardiologist evaluation and those who did not. The primary endpoint was major adverse cardiac events, defined as a composite of cardiovascular death, myocardial infarction, acute heart failure, and life-threatening arrhythmia at 365 days. The secondary endpoint was all-cause death at 365 days. Cox proportional hazards models were used to evaluate the association between cardiologist evaluation and outcomes. RESULTS: Among 14 294 patients, 1048 developed PMI and were eligible for this analysis, of whom 614 patients (58.6%) received post-operative cardiologist evaluation. Baseline characteristics were similar between groups. After adjustment, cardiologist evaluation was independently associated with lower risk of major adverse cardiac events (adjusted hazard ratio .54, P = .001) and all-cause death (adjusted hazard ratio .65, P = .037) at 365 days. Sensitivity analyses confirmed these findings. Patients receiving cardiology evaluation were more likely to undergo non-invasive cardiac imaging and to receive dual antiplatelet and statin therapy. CONCLUSIONS: Cardiologist evaluation of patients with PMI following major non-cardiac surgery was associated with a reduced risk of major adverse cardiac events and all-cause mortality at 365 days after surgery, suggesting that interdisciplinary management may improve post-operative outcomes.