One year after major noncardiac surgery, patients who received an evaluation for perioperative myocardial infarction/injury (PMI) by a cardiologist had a lower risk of all-cause mortality and major cardiac events, according to a multicenter prospective study published Jan. 30 in EHJ. The findings suggest that interdisciplinary management may improve postoperative outcomes in patients with PMI.

Noemi Glarner, MD, PhD, et al., evaluated outcomes in 14,294 high-risk patients (mean age 77 years, 45% women) undergoing noncardiac surgery who were eligible for the institutional PMI active surveillance and response program. They note that cardiologist evaluation of PMI was inconsistent because of staffing constraints, allowing for this comparison.

The primary endpoint was major adverse cardiac events (MACE) at one year, defined as a composite of life-threatening arrhythmia, acute heart failure, myocardial infarction and cardiovascular death. The secondary endpoint was all-cause death at one year.

A total of 1,048 patients developed PMI and were eligible for analysis, and 614 of them (58%) received postoperative cardiologist evaluation. Baseline characteristics were similar between groups.

Results showed that the cardiologist evaluation was associated with a lower risk of MACE (adjusted hazard ratio 0.54; p=0.001) and all-cause death (adjusted HR 0.65; p=0.037).

Of note, researchers found patients who had a cardiology evaluation were more likely to have noninvasive cardiac imaging and to receive dual antiplatelet and statin therapy.

Glarner and colleagues write that their findings have “important clinical implications.” Moving forward, they note that “future cost-effectiveness studies are warranted to help cardiology departments engage with hospital administration and payers regarding additional workload required for systematic cardiologist evaluation of patients with PMI.”

“This study provides evidence of clinical benefit and there is no evidence of harm,” write William S. Weintraub, MD, MACC, and William E. Boden, MD, FACC, in an accompanying editorial comment. “It is highly likely that all stakeholders, including [health care] professionals, [health care] systems, and especially patients will [favor] a structured consultation by a cardiologist in this setting.”