• Kurt Ruetzler, Esra Kutlu Yalcin, Praveen Chahar, Nathaniel R Smilowitz, Faith Factora, Xuan Pu, Elyad Ekrami, Kamal Maheshwari, Daniel I Sessler, and Alparslan Turan.
• Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America. Electronic address: ruetzlk@ccf.org.
• J Clin Anesth. 2022 Nov 1; 82: 110932.

Study ObjectiveChest pain is relatively common postoperatively. Myocardial infarction (MI) is one cause of chest pain after surgery, but chest pain also results from less severe conditions. Because of its potential severity, chest pain usually prompts the activation of Rapid Response Systems (RRS). While chest pain is a cardinal symptom of myocardial ischemia in the non-surgical setting, the significance and relevance of chest pain after noncardiac surgery remains unclear.DesignWe conducted a retrospective analysis of noncardiac surgical inpatients for whom postoperative chest pain triggered our multidisciplinary RRS.SettingSurgical wards at Cleveland Clinic, Cleveland, OH.PatientsPostsurgical patients after noncardiac surgery in whom the RSS system was activated for chest pain.InterventionsRRS specified interventions like ECG readings, troponin measurements, transfer to ICU.MeasurementsOur primary outcome was MI. Secondary outcomes included the proportion of patients who had an ECG performed, troponin measurements, echocardiography, cardiac catheterization, and were admitted to the Intensive Care Unit (ICU).Main Results5850 surgical patients experienced postoperative chest pain and triggered an RRS activation between 2009 and 2019. A total of 3110 patients had troponin T measured within 6 h after RRS activation, and 538 of them (17%) had elevated troponin, meeting the Fourth Universal Definition criteria for MI. Additionally, 2 patients had ST-segment elevation infarction (STEMI) without troponin measurement. Among the 540 patients with MI, only 19 (3.5%) were diagnosed with a STEMI by ECG, 388 (72%) had echocardiography, 43 patients (8%) had cardiac catheterization, 8 patients (1.5%) required emergent cardiac surgery, and 424 (79%) were admitted to an ICU.ConclusionChest pain is a serious clinical sign, often indicating a postoperative myocardial infarction, and therefore should be taken seriously. Troponin screening should be routinely considered in postsurgical patients who report chest pain.Copyright © 2022 Elsevier Inc. All rights reserved.

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