Kardiologie Cardiovascular Research Institute Basel Perioperative Myocardial Infarctions

Kardiologie Cardiovascular Research Institute Basel Perioperative Myocardial Infarctions The silent and neglected Killer Christian Puelacher, MD diss: kurs 03. 02. 2016 CRIB

Perioperative myocardial infarctions (PMI) = heart attacks and injuries occuring during or after non-cardiac surgery ! Christian Puelacher ? diss: kurs 03. 02. 2016 2

Guess the number of surgeries in: 900’ 000 >230 million Weiser, The Lancet 2008 Christian Puelacher diss: kurs 03. 02. 2016 3

* What surgeries? * * * More common with increasing age Christian Puelacher diss: kurs 03. 02. 2016 4 *

PMIs are challenging v Difficult to diagnose because mostly silent 16% No symptoms Any symptoms Botto, Anaesthesiology 2013 Christian Puelacher diss: kurs 03. 02. 2016 5

PMIs are challenging v Associated with relevant mortality Risk of death PMI Risk independent of symptoms Days after surgery Devereaux, JAMA 2012 Christian Puelacher diss: kurs 03. 02. 2016 6

Knowledge gaps PMI ? What is the pathophysiology of PMI? ? What is the long-term prognosis? ? How to best diagnose PMI? Plaque rupture with thrombus Supply-demand imbalance Christian Puelacher diss: kurs 03. 02. 2016 7

? My research Basel Incidence, Patient Characteristics, Outcome and possible Strategies to improve Outcome of Perioperative Myocardial Injury after non-cardiac surgery: 1 -Year Follow-up v PMI-Screening program for high-risk patients v Clinical observational trial Christian Puelacher diss: kurs 03. 02. 2016 8

? BASEL-PMI v Screening using cardiac blood marker Troponin Christian Puelacher diss: kurs 03. 02. 2016 9

? BASEL-PMI Study Flow Troponin measurment before surgery Christian Puelacher Surgery Troponin measurement after surgery diss: kurs 03. 02. 2016 10 Evaluation in case of PMI

? { } BASEL-PMI Study Flow Work up of Clinical files Christian Puelacher Adjudication of event Datacleaning Dataprocessing 1 year contact x 2000 diss: kurs 03. 02. 2016 11

? Research and Ph. D aims v Better understand PMI D iagnosis T reatment R isk Improve patient care Christian Puelacher diss: kurs 03. 02. 2016 12