Association between occurrence time of myocardial injury after noncardiac surgery and long-term functional capacity: a secondary analysis of a prospective study.

Background: Myocardial injury after noncardiac surgery (MINS) is associated with poor prognosis. The effect of different occurrence time of MINS on long-term functional capacity remains unclear in population with high cardiovascular risk.

Patients And Methods: This cohort study included adult patients with increased cardiovascular risk undergoing elective major noncardiac surgery from June 2019 to September 2021. Patients with MINS were stratified in two groups on the basis of the occurrence time of MINS: within 24  hour (h) or after 24 h. The primary endpoint was disability at 180 days after surgery, evaluated by World Health Organization Disability Assessment Schedule 2.0. Disability was defined as ≥25% or an increase of 8%. Multivariable logistic regression was adopted to explore the association between occurrence time of MINS and primary endpoint. Propensity score weighting, including inverse probability weighting and overlap weighting, and subgroup analysis were used to explore the relationship further.

Results: 2469 participants were included, of which 178 (7.2%) participants developed MINS within 24 h and 83 (3.4%) after 24 h. A total of 378 (15.3%) participants developed disability at 180 days after surgery, with an unweighted odds ratio (OR) of 1.97 (95% confidence intervals [CIs]: 1.17-3.32) for patients who suffered MINS after 24 h and weighted OR of 2.25 (95%CIs: 1.10-4.63) and 2.11 (95%CIs: 1.23-3.63) by IPW and OW, respectively. Findings were conserved in the subgroup analysis.

Conclusion: MINS occurring after 24 h was associated with worsen long-term functional capacity after surgery, whereas MINS occurring within 24 h was not.