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Coronary artery disease
Original research
Association between cardiologist evaluation and mortality in myocardial injury after non-cardiac surgery
  1. Jungchan Park1,
  2. Ah Ran Oh1,
  3. Ji-hye Kwon1,
  4. Sojin Kim1,
  5. Jeayoun Kim1,
  6. Kwangmo Yang2,
  7. Jin-Ho Choi3,
  8. Kyunga Kim4,5,
  9. Joonghyun Ahn4,
  10. Jidong Sung6,
  11. Seung-Hwa Lee6,7
  1. 1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  2. 2Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  3. 3Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  4. 4Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
  5. 5Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
  6. 6Rehabilitation & Prevention Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  7. 7Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea
  1. Correspondence to Dr Seung-Hwa Lee, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam Gu, Seoul 06351, South Korea; shuaaa.lee{at}samsung.com

Abstract

Objective Myocardial injury after non-cardiac surgery (MINS) is strongly associated with mortality, but few studies assessed treatment strategies. This study aimed to identify whether evaluation by cardiologists could reduce mortality in MINS patients.

Methods From a single-centre retrospective cohort, we enrolled a total of 5633 adult patients diagnosed with MINS between January 2010 and June 2019. The patients were divided into two groups based on evaluation by cardiologist, which was defined as a cardiology consultation or transfer to the cardiology department. For the outcome, 30-day mortality was compared in crude and propensity-score matched populations.

Results Of a total of 5633 patients, 2120 (37.6%) were evaluated by cardiologists and 3513 (62.4%) were not. Mortality during the first 30 days after surgery was significantly lower in MINS patients who were evaluated by cardiologists compared with those who were not (5.8% vs 8.3%; HR, 0.64; 95% CI 0.51 to 0.80; p<0.001 for all-cause mortality and 1.6% vs 2.0; HR 0.62; 95% CI 0.40 to 0.96; p=0.03 for cardiovascular mortality). The propensity score matched analysis showed similar results (5.6% vs 8.6%; HR 0.64; 95% CI 0.50 to 0.81; p<0.001 for all-cause mortality and 1.3% vs 2.2%; HR 0.58; 95% CI 0.35 to 0.95; p=0.03 for cardiovascular mortality).

Conclusions Cardiologist evaluation was associated with lower mortality in patients diagnosed with MINS. Further studies are needed to identify effective treatment strategies for MINS.

Trial registration number KCT0004244.

  • noncardiac surgery
  • biomarkers

Data availability statement

Data are available on reasonable request. The data we used for this study was curated using CDW (Clinical data Warehouse) which psuedonomynize the data from our institional electronic medical records. So, our data is deidentified by eliminating all identifiable variables such as name, social security number, hospital number, and etc. However, it is illegal to open this data to the public without restriction. Regarding the availability of our data, please contact jong-hwan.park@samsung.com, the head of our institutional data security department.

https://doi.org/10.1136/heartjnl-2021-319511

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    Data availability statement

    Data are available on reasonable request. The data we used for this study was curated using CDW (Clinical data Warehouse) which psuedonomynize the data from our institional electronic medical records. So, our data is deidentified by eliminating all identifiable variables such as name, social security number, hospital number, and etc. However, it is illegal to open this data to the public without restriction. Regarding the availability of our data, please contact jong-hwan.park@samsung.com, the head of our institutional data security department.

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    Footnotes

    • JP and ARO are joint first authors.

    • JP and ARO contributed equally.

    • Correction notice This article has been corrected since it was first published. '424 (1.0%) patients' in the Baseline characteristics section of the Results has been corrected to '242 (0.6%) patients'.

    • Contributors Conception or design of the work: SHL, JP and ARO. Acquisition, analysis or interpretation of data for the work: KK, JA, SK and JK. Drafting of the work: JP and ARO. Revising it critically for important intellectual content: SHL, KY, JH-C and JS. Final approval and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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