This is a prospective study in patients who undergo routine postoperative troponin assessment after major (semi-)elective noncardiac surgery. Two groups are created based on postoperative troponin levels: Postoperative myocardial injury (PMI) group with troponin I levels ≥ 60 ng/L and a control group with troponin levels \< 60ng/L. The primary aim of this study is to assess the association of PMI with pulmonary embolism. Additionally, the association between PMI and obstructive CAD will be investigated.
Study Type
OBSERVATIONAL
Enrollment
354
Coronary Computed Tomography Angiography will be performed in all participants
Pulmonary Embolism
Pulmonary embolism (PE) on either Coronary Computed Tomography Angiography (CCTA) or Ventilation/Perfusion (V/Q) scan. PE on CCTA is defined as a sharply delineated pulmonary artery filling defect in at least two consecutive image sections of the CCTA, either located centrally within the vessel or with acute angles at its interface with the vessel wall. PE on V/Q scan is defined as at least one segmental or two subsegmental perfusion defects without corresponding abnormality on chest X-ray.
Time frame: 1 week
Obstructive coronary artery disease
\> 50% stenosis in one or more epicardial vessels on CCTA
Time frame: 1 week
Obstructive main stem or proximal left anterior descending (LAD) stenosis
Incidence of obstructive (\>50%) main stem or proximal left anterior descending (LAD) stenosis
Time frame: 1 week
30-day MACE
Major adverse cardiovascular events within 30 postoperative days, which is defined as the composite of cardiovascular death, non-fatal myocardial infarction, non-fatal cardiac arrest, non-fatal ventricular fibrillation and ventricular arrhythmia with hemodynamic compromise.
Time frame: 30 days
30-day all-cause mortality
Time frame: 30-day
major diagnostic changes
Major Diagnostic change, which is defined as a clinically relevant change in diagnosis after CCTA in comparison to the most likely diagnosis before CCTA. The diagnosis prior to CCTA is made by the cardiology consultant and is based on routine clinical
Time frame: 1 week
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major therapeutic changes
Major Therapeutic change, which is defined as any change in in management of patients due to CCTA findings compared to the proposed treatment before CCTA
Time frame: 1 week
bleeding
bleeding within one year after surgery, which is based on TIMI criteria
Time frame: 1 year after surgery