Annually, between 10–15 million (3.3–5 per cent) patients will experience an acute perioperative myocardial infarction (PMI) or myocardial injury following non-cardiac surgery. Clinically apparent events only represent <20% of heart injuries, with more patients sustaining subclinical myocardial injuries (MINS). Risk of morbidity and mortality significantly elevate after MINS, yet insufficient evidence exists to inform treatment recommendations. The SHIELD Trial aims to fill this evidence gap, guide MINS management, and improve post-surgical patient outcomes.
Increased susceptibility following MINS for early recurrent MI and late heart failure makes secondary prevention of these events ideal therapeutic targets. Documented success of dual antiplatelet therapy (DAPT) in reducing the risk of recurrent MI following non-operative MI management and sodium-glucose cotransporter-2 inhibitor (SGLT2i) in prevention of heart failure progression suggests their potential use as secondary prevention strategies.
The SHIELD Pilot will randomise 50 participants to daily clopidogrel/placebo and aspirin (DAPT) and daily dapagliflozin/placebo (SGLT2i) for six months. Participants will have undergone major non-cardiac surgery and be identified by routine troponin screening to have suffered MINS. The pilot will evaluate factors including the screening and recruitment rates, drop-out rates, and trial processes. Pilot data will be used to optimise the protocol for the definitive trial.
Associate Professor Jonathon Fanning, Royal Brisbane and Women’s Hospital, Queensland;
Professor Graham Hillis, Royal Perth Hospital, Western Australia;
Professor Derek Chew, Monash Health, Melbourne;
Associate Professor David Highton, Princess Alexandra Hospital, Queensland;
Professor Gemma Figtree, Royal North Shore Hospital, NSW.
The project was awarded A$69,972 funding through the ANZCA research grants program for 2024.