‘Silent’ heart attacks remain a significant risk after surgery
Posted on February 4th, 2018

Embargo 0001H UK time Friday 20 September-The Association of Anaesthetists of Great Britain and Ireland (AAGBI)

A call is made today for increased awareness of ‘silent’ heart attacks that may follow surgery. In a session at this week’s Annual Congress of the Association of Anaesthetists of Great Britain and Ireland (AAGBI), Professor Daniel I. Sessler, Michael Chudahy Chair of the Department of Outcomes Research at the Cleveland Clinic, Ohio, USA, will present evidence that about one in 11 patients having major non-cardiac surgery will have a heart attack, and among these one in 10 will die within 30 days of the operation.

Some 80% of postoperative heart attacks are clinically silent, with no physical signs or symptoms to show that they have occurred. It is only through testing blood for the biomarker troponin that such heart attacks can be detected. Prof. Sessler will emphasise that currently few postoperative patients get troponin screening, but available data suggest that many more should so that timely treatments can be provided for those who have a heart attack.

”Blood concentration of troponin is the best indicator of a post-surgical heart attack. Furthermore, the test for troponin is inexpensive, quick, and accurate.” says Prof. Sessler. Many of these patients appear outwardly to be recovering well from their surgery. In four of five patients who have a postoperative heart attack, there are no clinical symptoms or signs: no chest pain or shortness of breath, and electrocardiograms and echocardiograms are normal. Clinicians will thus miss most of these heart attacks without specific blood testing for troponin.”

There are different options for treating such postoperative heart attacks, Prof. Sessler explains, but patients should at very least be started on aspirin. Other options include angiography and coronary artery stenting, or treatment with anticoagulant drugs. How to prevent heart attacks also remains unknown, although POISE-2, a major trial of low-dose clonidine and low-dose aspirin involving 10,000 patients, will finish by the end of 2013.

Available data, though, indicate that low blood pressure during surgery is strongly associated with both kidney injury and heart attacks. In most cases, naesthesiologists can prevent levels of hypotension that might be dangerous by giving less anaesthesia or drugs that raise blood pressure.” concludes Prof. Sessler.

AAGBI President Elect Andrew Hartle commented ’These are important findings with implications for improving patient care and making surgery even safer than it already is.” To contact Professor Daniel I. Sessler, Cleveland Clinic, Ohio, USA, please contact Wyatt DuBois, Senior Manager, Corporate Communications, Cleveland Clinic T) +1 216-445-9946 E) duboisw@ccf.org

Notes to editors:
What is moderate to high risk surgery? This is defined as operations on people aged 45 and
over requiring at least one night in hospital

How many surgical procedures a year? There are approximately 240 million non-cardiac
surgeries carried out globally each year. Prof Sessler estimates that at least one third of
these would be moderate-to-high risk surgeries.

Electrocardiograms look at the electrical activity of the heart

Echocardiograms use ultrasound to show how the heart muscle is contracting in real time
Angiography involves injecting dye to see the blood supply to the heart, and allows
cardiologists to open blocked arteries with drugs or stents to restore the interrurpted blood
supply that causes a heart attack.

Anticoagulant drugs thin the blood and prevent from clotting, although they are useful in
treating heart attacks, they increase the risk of bleeding associated with surgery.

AAGBI contact:
Karin Pappenheim, Executive Director, AAGBI
T) +44 (0) 20 7631 8802; +44 (0) 7825 295745 E) karinpappenheim@aagbi.org
Varsha Ramani, Communications Manager, AAGBI
T) +44 (0) 20 7631 8854; +44 (0) 7825 299549 E) varsharamani@aagbi.org
Alternative contact: Tony Kirby of Tony Kirby PR Ltd. T) +44 7834 385827 E)
About the AAGBI
The Association of Anaesthetists of Great Britain and Ireland (AAGBI) is the leading membership
body for over 10,500 anaesthetists in the UK and Ireland. The AAGBI promotes patient care,
safety and advances anaesthesia through education, publications, research and international
work, as well as the professional aspects of the specialty.
To find out more about the work of the AAGBI, visit www.aagbi.org
About the AAGBI Annual Congress 2013
Annual Congress is the flagship event of the AAGBI and the 2013 conference is being held at
Dublin from 18-20 September. The Annual Congress is one of the leading anaesthetic meetings,
with an attendance of around 800-1000 national and international delegates. It features
informative sessions, high profile speakers and an extensive trade exhibition. Aimed at all levels
of anaesthetists from trainees to consultants, it is a European CPD accredited meeting.
For more information on the meeting, please visit www.annualcongress.org

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