Physician Practices in the Management of Myocardial Injury after Non-Cardiac Surgery A Survey Study
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Keywords
myocardial injury, myocardial injury after noncardiac surgery, Myocardial Injury after Non-Cardiac Surgery, MINS, treatment, diagnostic testing
Abstract
Objective: To describe how physicians manage patients with myocardial injury (i.e., a troponin elevation of presumed ischemic origin) after non-cardiac surgery (MINS).
Methods: Web-based survey to physicians distributed between December 2020 and September 2021, including a case scenario of asymptomatic MINS.
Results: Of 103 respondents, 94% were practicing in Canada and 65% were general internists. 97% of respondents would order an ECG; following a normal ECG, 46% of would order an echocardiogram; following a normal echocardiogram, 42% would order myocardial perfusion imaging. Of the respondents, 91% and 90% would initiate ASA and a statin, respectively; 24%, 21%, and 7% would initiate an ACE inhibitor, a beta-blocker, and dabigatran, respectively. Most participants indicated that outpatient follow-up with a medicine specialist within 1–2 months (90%) and 1 year (68%) was appropriate.
Conclusion: Respondents generally agreed that ASA and statins should be prescribed for MINS, and that post-discharge specialist follow-up is warranted. However, opinions regarding the role of cardiac imaging varied.
Résumé
Objectif: Décrire la manière dont les médecins prennent en charge les patients atteints d’une lésion myo-cardique (c’est-à-dire une élévation de la troponine d’origine ischémique présumée) à la suite d’une intervention chirurgicale non cardiaque (MINS pour myocardial injury after non-cardiac surgery).
Méthodologie: Enquête en ligne menée auprès de médecins et distribuée entre décembre 2020 et septembre 2021 et comprenant un scénario de cas de MINS asymptomatique.
Résultats: Sur les 103 répondants au sondage, 94% pratiquent au Canada et 65% sont des internistes généralistes. Une proportion de 97% des répondants demanderaient un ECG; si l’ECG s’avère normal, 46% demanderaient un échocardiogramme; s’il s’avère normal, 42% demanderaient une imagerie de perfusion myocardique. Une proportion de 90 à 91% des répondants prescriraient un traitement par l’acide acétylsalicylique (ASA) ou une statine; 24% un traitement par un inhibiteur de l’enzyme de conversion de l’angioten-sine (IECA), 21% un traitement par un bêtabloquant et 7% un traitement par le dabigatran. La plupart des participants indiquent qu’il est approprié d’assurer un suivi en consultation externe par un spécialiste dans le mois ou les deux mois (90%) et un an (68%) suivant l’intervention.
Conclusion: Les répondants au sondage sont généralement d’avis que l’ASA et les statines devraient être prescrits pour la MINS et qu’il est justifié d’assurer un suivi par un spécialiste après la sortie de l’hôpital. Les avis concernant le rôle de l’imagerie cardiaque varient.
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Asher Selznick, McMaster University, Hamilton, ON, Canada
Department of Surgery, McMaster University
Michael Ke Wang, McMaster University, Hamilton, ON, Canada
Department of Medicine, McMaster University
Department of Health Research Methods, Evidence, and Impact, McMaster University;
Population Health Research Institute, McMaster University
Flavia Borges, McMaster University, Hamilton, ON, Canada
Department of Medicine, McMaster University
Population Health Research Institute, McMaster University
David Conen, McMaster University, Hamilton, ON, Canada
Department of Medicine, McMaster University
Population Health Research Institute, McMaster University
Steffen Blum, McMaster University, Hamilton, ON, Canada; University Hospital Basel, Basel Switzerland
Population Health Research Institute, McMaster University
Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel
PJ Devereaux, McMaster University, Hamilton, ON, Canada
Department of Medicine, McMaster University
Department of Health Research Methods, Evidence, and Impact, McMaster University
Population Health Research Institute, McMaster University
Maura Marcucci, McMaster University, Hamilton, ON, Canada
Department of Medicine, McMaster University
Department of Health Research Methods, Evidence, and Impact, McMaster University
Population Health Research Institute, McMaster University