Wednesday, December 13, 2017

Even Non-Heart Surgery May Harm Your Heart

Older adults commonly suffer damage to heart cells during various types of surgery – even non-heart related surgeries – and it can significantly raise their risk of dying from the procedure, a new study finds.

The research looked at a phenomenon called perioperative myocardial injury, or PMI. It refers to subtler heart damage that can happen during or soon after any type of surgery. Old patients and those who already have heart disease are at increased risk.

However, the condition is easily missed because most of the affected patients have no chest pain or other symptoms, according to Dr. Christian Puelacher, the first author on the new study. He’s a clinical researcher at Cardiovascular Research Institute Basel in Switzerland.

Puelacher’s team found that PMI may happen more often than doctors have typically thought: Of more than 2,000 high-risk patients screened, 1 in 7 developed PMI after a non-cardiac surgery, the study found.

“This suggests we’ve underestimated the number of myocardial [heart] injuries that occur during non-cardiac surgery,” said Dr. Alistair Phillips, co-chair of the surgeons’ section leadership council for the American College of Cardiology.

The cases were found because all of the patients – treated at the University Hospital Basel in Switzerland – were screened for PMI with a newer blood test: a so-called “high sensitivity” troponin test, which detects elevations in the heart protein troponin. When troponin levels rise, it’s a sign of heart damage, Phillips explained.

High-sensitivity troponin tests have been used in Europe and elsewhere for several years, but have only recently become available in the United States. The U.S Food and Drug Administration approved the first such test earlier this year.

Most often, the study found, patients had no telltale signs of heart damage. Only 6% had chest pain, while 18% had any symptoms to signal that blood and oxygen flow to the heart was being impaired.

The study findings were published in the Dec. 4 online issue of the journal Circulation.

My Take:
I understand the FDA being cautious about new drugs and medical procedures but the delay(s) associated with approving a simple blood test that has no risk to the patient is unfounded.

This reminds me of the “high sensitivity” CRP (C-reactive protein), a marker for artery inflammation. The test is an excellent indicator of cardiac risk, but seldom performed. Most physicians depend on the LDL or total cholesterol in determining cardiac risk and both are extremely inaccurate. The limited value of statin drugs is the ability to lower CRP, not the LDL cholesterol.

As we age, the risk of injury from any surgical procedure rises. Some of this is related to long-term and even permanent side effects of anesthesia. Unfortunately, physicians are using this information to push for elective surgeries at ever younger ages. It is not uncommon for a patient to have a total hip or total knee replacement in their 50’s today – an event that was unheard of just a few years ago.

The Bottom Line:
If you are middle aged or older, insist on having your troponin run using the “high sensitivity” method after any surgical procedure.

Source: December 4, 2017 National Institutes of Health

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