Outcome
Type |
Measure |
Description |
Time frame |
Safety issue |
Other |
Estimate potential effect of detection and management of PMI on major adverse cardiac events by a screening program implemented within clinical routine |
|
1 year |
|
Other |
Compare cardiac troponin T and I in the detection of PMI |
|
3 days after surgery |
|
Primary |
Deaths in one year after non-cardiac surgery in patients with and without PMI |
|
1 year |
|
Secondary |
MACE in one year after non-cardiac surgery in patients with and without PMI |
MACE is defined as a composite of death, acute myocardial infarction, life-threatening arrhythmia (cardiac arrest, sustained ventricular tachycardia, atrioventricular (AV) -block III), or acute heart failure (requiring admission to a hospital or intra-hospital transfer to the intensive care unit) within one year. Two independent cardiologists or anaesthesiologists will adjudicate all MACE. |
1 year |
|
Secondary |
Incidence of PMI within a screening program in high-risk patients undergoing major non-cardiac surgery |
PMI is defined as an absolute increase in h/s-cTn of the 99th percentile of healthy individuals for the respective assay above baseline cTn-value or between two postoperative values if the preoperative value was missing. PMI will be further classified as type I myocardial infarction, type II myocardial infarction, or myocardial injury due to non-cardiac causes. |
3 days after surgery |
|
Secondary |
Number of patients with PMI with ischemic symptoms and signs detected in a screening program in high-risk patients undergoing major non-cardiac surgery |
Patients with PMI are evaluated for: presence of chest pain, atypical symptoms, palpitations, dyspnea, edema, or nausea; ST-changes, Q-waves, T-wave abnormalities, new bundle branch block |
3 days after surgery |
|
Secondary |
Number of patients with PMI with management changes after screening-induced consultation |
Changes in management can be: changes in medication, intensification of surveillance, call for use of coronary angiography, myocardial stress testing, other, or none |
3 days after surgery, followed for 1 year |
|
Secondary |
Generate a pre- and an immediate postoperative prediction score for occurrence of major adverse cardiac events including PMI |
|
1 year |
|
Secondary |
Costs related to the introduction of perioperative hs-cTnT screening. |
Health system costs of implementation of screening is calculated as number of interventions initiated additionally to routine care after screening |
1 year |
|
Secondary |
Derive and validate a risk score in patients with different subtypes of PMI for the occurrence of major cardiac adverse events to inform treatment decisions. |
Endpoint: percentage of correctly classified patients in validation cohort. |
1 year |
|
Secondary |
Derive and validate an improved diagnostic screening approach for detection of PMI. |
Endpoint: sensitivity and specificity for PMI. |
3 days after surgery |
|
Secondary |
Evaluate the effect of pre-operative medication use. |
Endpoint: number of patients undergoing elective non-cardiac surgery suffering PMI (cardiac origin) after non-cardiac surgery with vs without pre-operative statin/RAAS blocker/ß-blocker therapy. |
3 days after surgery |
|
Secondary |
Evaluate the effect of post-PMI medication on outcome of PMI. |
Endpoint: death and MACE in patients suffering PMI (cardiac origin) with vs without statin/RAAS blocker/ß-blocker therapy. |
1 year |
|
Secondary |
Description of PMI subtypes and potential diagnostic criteria available at time of PMI detection. |
|
3 days after surgery |
|
Secondary |
Validate the diagnosis of PMI within a screening program in high-risk patients undergoing major non-cardiac sur-gery with other troponin assays. |
PMI is defined as an absolute increase in h/s-cTn of the 99th percentile of healthy individuals for the respective assay above baseline cTn-value or between two postoperative values if the preoperative value was missing. |
3 days after surgery |
|