Implementation of a Clinical Screening and Response System for Cardiac Complications After Noncardiac Surgery

NCT ID: NCT05859620

Last Updated: 2025-03-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

900 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-07-01

Study Completion Date

2025-12-31

Brief Summary

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The investigators aim to show the feasibility and medicoeconomic impact of implementing a clinical screening and response system for the early detection of perioperative cardiac complications in high-risk patients.

Specifically, the investigators aim to: 1) evaluate the feasibility of implementation of a PMI-screening; 2) evaluate the medicoeconomic impact of implementing a PMI-screening; 3) identify barriers to implementation; 4) generate data for a future randomized controlled trial on outcomes by exploring opportunities to improve care following PMI, the occurrence and timing of major adverse cardiac events (MACE), and the treatment effect associated with PMI-screening.

Detailed Description

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Background: Perioperative myocardial infarction/injury (PMI) is increasingly recognised as frequent, but often undiagnosed and untreated contributor to mortality following noncardiac surgery. Due to differences in pathophysiology and perioperative anaesthesia and analgesia, most PMI do not cause typical ischemic symptoms and are therefore missed in routine clinical practice. Active surveillance using cardiac troponin (cTn) is now guideline-recommended for the early detection of PMI to possibly improve outcome1. Given substantial concerns regarding the feasibility and health economic impact of implementing such a strategy, it is not yet widely applied.

Aim: to show feasibility of implementation as well as health economic impact of an active surveillance for the early detection of PMI in high-risk patients.

Methodology: in this observational before-after study the investigators will enrol patients at high cardiovascular risk undergoing noncardiac surgery before and after implementation of a PMI screening. Patients in the pre-implementation phase will receive standard of care, while in the post-implementation phase patients receive a PMI-screening, consisting of a preoperative and two postoperative measurements of high-sensitivity cTn (hs-cTn) and a cardiology consultation will be done in case of detection of a PMI. Patient data, resource utilisation, and PMI-aetiology will be collected. Interviews with key stakeholders will identify barriers to implementation. One-year follow-up will be conducted to evaluate occurrence of death, MACE, and safety endpoints.

Potential significance: This study will generate important insights regarding the feasibility, safety and the health economic impact of implementing an active surveillance for the early detection of PMI.

Conditions

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Myocardial Injury Myocardial Infarction Perioperative Complication

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Before implementation

Patients included before implementation of the PMI-screening

Patient assessment and follow-up

Intervention Type OTHER

There is no study-specific intervention. The investigators will record data generated by clinical activity before, during and after implementation of the PMI-screening. Follow-up data and the final PMI event adjudication will be the only data generated specifically for this study.

After implementation

Patients included after implementation of the PMI-screening

Patient assessment and follow-up

Intervention Type OTHER

There is no study-specific intervention. The investigators will record data generated by clinical activity before, during and after implementation of the PMI-screening. Follow-up data and the final PMI event adjudication will be the only data generated specifically for this study.

Interventions

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Patient assessment and follow-up

There is no study-specific intervention. The investigators will record data generated by clinical activity before, during and after implementation of the PMI-screening. Follow-up data and the final PMI event adjudication will be the only data generated specifically for this study.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Consecutive patients fulfilling the institutional criteria for inclusion into the routine PMI-screening
* aged 40-85 years
* at increased cardiovascular risk
* undergoing inpatient, noncardiac, elective or emergent surgery
* postoperative stay of ≥2 nights at the participating institution
* orthopaedic, traumatology, vascular, spinal, thoracic, neurosurgical, and visceral surgery.

Exclusion Criteria

* patients with cardiac surgery or interventions in the last 14 days
* chronic renal failure under dialysis, renal transplant surgery
* moderate-to-severe dementia
* previous inclusion within 5 days
* documented refusal to use of their data for research purposes or refusal of further use during follow-up
* Patients declining consent for follow-up will be excluded from follow-up analyses.
Minimum Eligible Age

40 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Luzerner Kantonsspital

OTHER

Sponsor Role collaborator

Kantonsspital Olten

OTHER

Sponsor Role collaborator

Medical University Innsbruck

OTHER

Sponsor Role collaborator

University Hospital, Geneva

OTHER

Sponsor Role collaborator

Bürgerspital Solothurn

OTHER

Sponsor Role collaborator

University Hospital, Basel, Switzerland

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Christian Puelacher, MD-PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Basel, Switzerland

Christian Müller, Prof.

Role: STUDY_DIRECTOR

University Hospital, Basel, Switzerland

Locations

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University Hospital Innsbruck

Innsbruck, Tyrol, Austria

Site Status RECRUITING

University Hospital Geneva

Geneva, Canton of Geneva, Switzerland

Site Status NOT_YET_RECRUITING

Cantonal Hospital Lucerne

Lucerne, Canton of Lucerne, Switzerland

Site Status RECRUITING

Canton Hospital Olten

Olten, Canton of Solothurn, Switzerland

Site Status ACTIVE_NOT_RECRUITING

Bürgerspital Solothurn

Solothurn, , Switzerland

Site Status RECRUITING

Countries

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Austria Switzerland

Central Contacts

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Christian Puelacher, MD-PhD

Role: CONTACT

+41 76 403 44 50

Christian Müller, Prof.

Role: CONTACT

+41 61 328 65 49

Facility Contacts

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Judith Martini, MD, PD

Role: primary

+43 512 504 80478

Petra Hillinger, MD

Role: backup

+43 512 504 80449

Bernardo Bollen Pinto, MD, PhD

Role: primary

+41 795532125

Matthias Bossard, MD

Role: primary

+41 41 205 14 77

Nisha Arenja, PD

Role: primary

0041 62 311 41 30

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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2020-02899

Identifier Type: -

Identifier Source: org_study_id

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