Why cardiologist evaluation matters after non-cardiac surgery

By Hugo Francisco de SouzaReviewed by Lauren HardakerFeb 3 2026

Many post-surgical heart injuries go unnoticed, but cardiologist input can change outcomes.

Study: Peri-operative myocardial infarction/injury after non-cardiac surgery: association between cardiologist evaluation and outcomes. Image credit: PeopleImages/Shutterstock.com

In a recent study published in the European Heart Journal, researchers analyzed data from more than 1,000 patients who developed perioperative myocardial injury to explain the potential mortality benefits of including a cardiologist in non-cardiac procedures, particularly for high-risk patients.

Study findings revealed that cardiologists can substantially improve outcomes, with patients who received a formal evaluation by a cardiologist demonstrating a 46 % lower risk of major adverse cardiac events and a 35 % lower risk of death from any cause within one year compared to those managed solely by the surgical team. These findings highlight the critical need for interdisciplinary collaboration in modern surgical care.

Why postoperative heart damage often goes unnoticed

Advances in modern surgery have made the field safer and more routine, allowing older patients and those with chronic conditions to undergo life-improving procedures. However, recent research suggests that the stress surgery places on the body can lead to a condition known as perioperative myocardial infarction or injury (PMI).

Contrasting traditional heart attacks, which often trigger severe crushing chest pain, PMI attacks are often silent (asymptomatic) or masked by post-surgical pain medication, making them easy to miss without active blood testing. These findings suggest that including a cardiologist on an operative team, even for non-cardiac surgeries, may be beneficial, but while pilot studies have hinted at this effect, robust outcome data have remained limited.

Furthermore, the debate concerning cardiologist inclusion is compounded by the reality of hospital staffing; on weekends, public holidays, or busy days, specialized consults may not be available, leaving surgeons to manage these complex cardiovascular issues alone.

A real-world staffing gap creates a natural experiment

The present study aimed to inform this debate and future post-operative care by conducting an extensive, prospective two-centre study in Switzerland, involving 14,294 high-risk patients undergoing major non-cardiac surgery. The study focused specifically on 1,048 patients diagnosed with PMI via active surveillance of cardiac troponin (cTn), a blood-borne protein biomarker detectable after heart muscle damage.

The study notably leveraged a natural experiment created by real-world staffing constraints. Whether a patient saw a cardiologist often depended on operational factors rather than medical necessity, for example, patients were less likely to be evaluated if their heart injury occurred on a weekend, a public holiday, or when the on-call cardiologist was occupied with urgent emergencies.

This inherent stochastic variability enabled analyses to compare two groups, those who received a cardiologist evaluation (614 patients) and those who did not (434 patients), while adjusting for variables such as age, pre-existing cardiovascular disease, and surgical risk. The study's primary endpoint measured was the occurrence of Major Adverse Cardiac Events (MACE), defined as a composite of cardiovascular death, heart attack, acute heart failure, or life-threatening arrhythmia from postoperative day three through 365 days after surgery.

Cardiologist evaluation links to fewer cardiac events

The study analyses revealed that cardiac specialist advice and post-operative care were associated with a statistically significant protective effect over the following year of follow-up. Specifically, the study found that cardiologist involvement was independently associated with a 46 % lower risk of MACE at 365 days (adjusted Hazard Ratio aHR 0.54, p = 0.001). Furthermore, the risk of death from any cause was reduced by 35 % in the consulted group (aHR 0.65, p = 0.037).

While the study design was observational and therefore cannot establish causality, the authors note that residual confounding cannot be fully excluded, and suggest that the observed outcomes likely arose from optimized medical management rather than differences in surgical quality.

Patients seen by cardiologists were more likely to undergo non-invasive imaging, such as echocardiography (ultrasound of the heart) and stress testing. Consequently, they were more frequently prescribed evidence-based medications, including statins and dual antiplatelet therapy, to protect the heart. Importantly, the cardiologist's evaluation did not follow a single protocol but instead reflected a range of individualized diagnostic and therapeutic decisions.

Although invasive procedures remained uncommon overall, coronary angiography was more frequently performed in patients evaluated by cardiologists, though still in fewer than 10 % of cases, suggesting that targeted diagnostics and medical optimization, rather than routine invasive intervention, may be sufficient to improve outcomes.

Specialist cardiac input may improve non-cardiac surgical outcomes

The present study provides strong observational evidence of an association between interdisciplinary medical and surgical management, particularly the involvement of a cardiac specialist following non-cardiac surgery, and improved long-term outcomes in high-risk patients who develop perioperative myocardial injury.

Study findings, particularly the observed links between cardiologist evaluation and reduced mortality, suggest that the silent nature of perioperative heart injury may require specialized expertise to optimize medication use, diagnostic evaluation, and clinical monitoring.

The study further highlights an ongoing logistical challenge faced by many hospitals: patients may miss timely cardiology evaluations due to staffing limitations on weekends or holidays. As surgical volumes continue to rise globally, healthcare systems may need to implement more robust triage pathways or expand telemedicine services to ensure that every patient with perioperative heart injury, regardless of the day of the week, receives appropriate cardiac expertise.

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