Observational studyAge and ageing2026
Prevalence and prognostic relevance of perioperative myocardial injury/infarction after major noncardiac surgery in older patients.
Observational study in Age and ageing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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24 authors.
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Abstract
backgroundThe prognostic relevance of perioperative myocardial injury/infarction (PMI) in older patients undergoing major noncardiac surgery remains unclear, as high comorbidity burden may lessen its impact.
methodsOlder patients (defined as age ≥70 years with ≥3 comorbidities, or ≥80 years) enrolled in a multicentre, prospective study of patients at increased cardiovascular risk undergoing major noncardiac surgery were analysed. The primary endpoint, all-cause mortality at 1 year, was analysed using Cox proportional hazards regression. Secondary endpoints included major adverse cardiac events (MACE) (cardiovascular death, acute myocardial infarction, life-threatening arrhythmia and acute heart failure), analysed using Fine-Grey hazard regression. All models were adjusted for prespecified confounders with PMI as a time-varying exposure.
resultsAmongst 4634 older patients (median age 80 years; 42.9% women), PMI occurred in 892 patients (19.2%), which was higher than in younger patients (P < .0001). The distribution of PMI aetiologies was comparable between groups. At 1 year, all-cause mortality was 26.2% in patients with PMI and 13.2% in patients without PMI, and MACE occurred in 30% versus 13%, respectively. After multivariable adjustment, the hazard ratio of PMI was highest on postoperative day 1 (all-cause mortality: 10.5 [95% CI 4.5-24.5]; MACE: 4.4 [95% CI 3.2-5.9]), declined by day 90 (1.4 [95% CI 1.0-1.9] and 2.2 [95% CI 1.7-2.7], respectively), and persisted through 1 year.
conclusionsPMI was very common amongst older patients and associated with substantially higher 1-year risks of all-cause mortality and MACE, with greatest vulnerability observed during the initial 90 postoperative days.
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