A new study published in the European Heart Journal suggests that consulting a cardiologist after non-cardiac surgery may lower the risk of death and serious heart problems. The research, led by Dr Christian Puelacher, Dr Noemi Glarner, and Professor Christian Müller from the University of Basel, Switzerland, examined patients who experienced heart damage during or soon after surgery.
The study involved 14,294 high-risk patients aged 65 or older or with existing cardiovascular disease who underwent non-cardiac surgeries at University Hospital Basel or Cantonal Hospital Aarau. All patients received blood tests to check troponin levels—a marker for heart injury—after their operations. Of these, 1,048 were found to have suffered a heart attack or similar injury around the time of surgery.
Out of those affected, 614 patients (58.6%) were evaluated by a cardiologist while 434 (41.4%) were not, often due to specialist unavailability on weekends or holidays. Researchers compared outcomes between these groups and found that those seen by a cardiologist had a 35% lower chance of dying within one year and were 46% less likely to experience further major heart events such as another heart attack, sudden heart failure, irregular heartbeat, or death from cardiac causes. These patients also received more advanced imaging tests and stronger medications.
Dr Puelacher explained: "With our aging population, surgery is increasingly common. Even when surgery is not on the heart, the heart is challenged by the stress of surgery, including anesthesia, blood loss, inflammation and changes in blood pressure. This can lead to perioperative myocardial infarction/injury, or PMI for short."
He added that PMI occurs in about 15% of high-risk surgical patients—often without symptoms—and strongly predicts complications and death following surgery.
Dr Glarner commented: "No prior research has examined this specific intervention with comparable rigor or sample size. However, this is an observational study, which cannot prove cause-and-effect, even with strong adjustments for other factors. As gold-standard, a randomised controlled trial is needed to ultimately confirm the results."
She emphasized: "Surgery is only carried out for good reason and following careful assessment of the risks, but complications do still occur. It's vital to screen for PMI in patients who are risk. Where signs of heart injury are found, a cardiologist can ensure patients get the monitoring and treatment they need."
The team is now conducting further studies across hospitals in Switzerland and Austria to implement routine screening for PMI.
In an editorial accompanying the publication, Professor William Weintraub from Georgetown University noted: "This is a valuable study concerning an important and potentially modifiable management issue in patients who sustain a PMI in hospital after non-cardiac surgery. The study was conducted rigorously... While the statistical approaches to reduce bias were appropriate... it is not possible to account for unmeasured confounding variables... Though the hazard ratios for reduced MACE and all-cause mortality are impressive... they remain in a range (e.g., perhaps >0.5) where unmeasured confounders could account for the observed association."
He concluded: "The authors were judicious in their conclusions... In summary... do the findings of this study provide sufficient justification to recommend that a cardiology consult be undertaken in the setting of post-surgical post-operative MI? The answer is at least provisionally yes. This study provides evidence of clinical benefit and there is no evidence of harm..."
