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Xi S, Wang B, Su Y, Lu Y, Gao L. Predicting perioperative myocardial injury/infarction after noncardiac surgery in patients under surgical and medical co-management: a prospective cohort study. BMC Geriatr 2024; 24:540. [PMID: 38907213 PMCID: PMC11193176 DOI: 10.1186/s12877-024-05130-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/06/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Perioperative myocardial injury/infarction (PMI) following noncardiac surgery is a frequent cardiac complication. This study aims to evaluate PMI risk and explore preoperative assessment tools of PMI in patients at increased cardiovascular (CV) risk who underwent noncardiac surgery under the surgical and medical co-management (SMC) model. METHODS A prospective cohort study that included consecutive patients at increased CV risk who underwent intermediate- or high-risk noncardiac surgery at the Second Medical Center, Chinese PLA General Hospital, between January 2017 and December 2022. All patients were treated with perioperative management by the SMC team. The SMC model was initiated when surgical intervention was indicated and throughout the entire perioperative period. The incidence, risk factors, and impact of PMI on 30-day mortality were analyzed. The ability of the Revised Cardiac Risk Index (RCRI), frailty, and their combination to predict PMI was evaluated. RESULTS 613 eligible patients (mean [standard deviation, SD] age 73.3[10.9] years, 94.6% male) were recruited consecutively. Under SMC, PMI occurred in 24/613 patients (3.9%). Patients with PMI had a higher rate of 30-day mortality than patients without PMI (29.2% vs. 0.7%, p = 0.00). The FRAIL Scale for frailty was independently associated with an increased risk for PMI (odds ratio = 5.91; 95% confidence interval [CI], 2.34-14.93; p = 0.00). The RCRI demonstrated adequate discriminatory capacity for predicting PMI (area under the curve [AUC], 0.78; 95% CI, 0.67-0.88). Combining frailty with the RCRI further increased the accuracy of predicting PMI (AUC, 0.87; 95% CI, 0.81-0.93). CONCLUSIONS The incidence of PMI was relatively low in high CV risk patients undergoing intermediate- or high-risk noncardiac surgery under SMC. The RCRI adequately predicted PMI. Combining frailty with the RCRI further increased the accuracy of PMI predictions, achieving excellent discriminatory capacity. These findings may aid personalized evaluation and management of high-risk patients who undergo intermediate- or high-risk noncardiac surgery.
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Affiliation(s)
- Shaozhi Xi
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No.28 Fu Xing Road, Beijing, 100853, China
| | - Bin Wang
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No.28 Fu Xing Road, Beijing, 100853, China
| | - Yanhui Su
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No.28 Fu Xing Road, Beijing, 100853, China
| | - Yan Lu
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No.28 Fu Xing Road, Beijing, 100853, China.
| | - Linggen Gao
- Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No.28 Fu Xing Road, Beijing, 100853, China.
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Goyal A, Ekelmans A, Frishman W. Exploring the Intersection of Dementia and Myocardial Infarction: Vascular Perspectives. Cardiol Rev 2024:00045415-990000000-00272. [PMID: 38771949 DOI: 10.1097/crd.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
Emerging evidence underscores the relationship between myocardial infarction and dementia, implicating a profound influence on patient health. The bidirectional relationship between myocardial infarction and dementia is highlighted by pathophysiological changes in vasculature function, lifestyle factors, and environmental influences. Our literature review aims to explore the complex relationship between these 2 pathologies and highlight the pathways by which they mutually influence each other.
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Affiliation(s)
- Anjali Goyal
- From the School of Medicine, New York Medical College, Valhalla, NY
| | | | - William Frishman
- From the School of Medicine, New York Medical College, Valhalla, NY
- Department of Medicine, New York Medical College, Valhalla, NY
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Zheng K, Bor WL, Kelder JC, Hackeng CM, Kropman RHJ, Ten Berg JM, Noordzij PG. Postoperative Myocardial Injury and Inflammatory Biomarkers in Patients Undergoing Vascular Surgery: A Subanalysis of the Platelet Reactivity and Postoperative Myocardial Injury after Major Vascular Surgery (PROMISE) Study. Ann Vasc Surg 2024; 102:202-208. [PMID: 37926141 DOI: 10.1016/j.avsg.2023.09.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/12/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Postoperative myocardial injury (PMI) is associated with morbidity and mortality, but the aetiology remains unclear. We studied whether PMI is associated with perioperative systemic inflammation. The objective is the examination of the relationship between inflammatory biomarkers (Interleukin 6[IL-6], C-reactive protein [CRP]) and PMI, detected by elevated cardiac troponin (cTn), in patients undergoing elective open abdominal aortic surgery. METHODS This prospective, single-center, observational cohort study included 54 patients undergoing elective open abdominal aortic surgery between March 2018 and April 2021. Patients were routinely treated with aspirin. IL-6 and CRP were measured preoperatively, directly after surgery, 24 hr and 48 hr postoperatively. The primary outcome was cTn release assessed by a fifth-generation high-sensitive cTn assay. Multivariable generalized linear regression models were used to evaluate the association between inflammatory biomarkers and cTn concentrations. RESULTS Fifteen patients (27.8%) developed PMI. IL-6 directly and 24 hr postoperatively was associated with elevated cTn concentrations (1.28 [1.07-1.54], P = 0.009) and 1.75 [1.18-2.59], P = 0.006, respectively). Also, CRP directly and 24 hr postoperatively was associated with elevated cTn concentrations (1.25 [1.06-1.47], P = 0.009) and 1.61 [1.1-2.33], P = 0.013, respectively). No association was found between IL-6 or CRP and cTn concentrations when measured at 48 hr postsurgery. CONCLUSIONS Biomarkers of inflammation are associated with elevated postoperative cTn concentrations in the early postoperative period in patients undergoing elective open abdominal aortic surgery.
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Affiliation(s)
- Kailiang Zheng
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Willem L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Johannes C Kelder
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Chris M Hackeng
- Department of Clinical Chemistry, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Rogier H J Kropman
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; University Medical Centre Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Peter G Noordzij
- Department of Anaesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands; Department of Anaesthesiology, Intensive Care and Pain medicine, University Medical Centre, Utrecht, the Netherlands.
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Mases A, Beltrán de Heredia S, Gallart L, Román L, Bosch L, Núñez M, Rueda M, Recasens L, Sabaté S. Prediction of Acute Myocardial Injury in Noncardiac Surgery in Patients at Risk for Major Adverse Cardiovascular and Cerebrovascular Events: A Multivariable Risk Model. Anesth Analg 2023; 137:1116-1126. [PMID: 37043386 DOI: 10.1213/ane.0000000000006469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND The best use of perioperative cardiac biomarkers assessment is still under discussion. Massive postoperative troponin surveillance can result in untenably high workloads and costs for health care systems and potentially harmful interventions for patients. In a cohort of patients at risk for major adverse cardiovascular and cerebrovascular events (MACCEs), we aimed to (1) determine whether preoperative biomarkers can identify patients at major risk for acute myocardial injury in noncardiac surgery, (2) develop a risk model for acute myocardial injury prediction, and (3) propose an algorithm to optimize postoperative troponin surveillance. METHODS Prospective, single-center cohort study enrolling consecutive adult patients (≥45 years) at risk for MACCE scheduled for intermediate-to-high-risk noncardiac surgery. Baseline high-sensitivity troponin T (hsTnT) and N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP), as well as hsTnT on the first 3 postoperative days were obtained. The main outcome was the occurrence of acute myocardial injury. Candidate predictors of acute myocardial injury were baseline concentrations of hsTnT ≥14 ng/L and NT-proBNP ≥300 pg/mL and preoperative and intraoperative variables. A multivariable risk model and a decision curve were constructed. RESULTS Of 732 patients, 42.1% had elevated hsTnT and 37.3% had elevated NT-proBNP levels at baseline. Acute myocardial injury occurred in 161 patients (22%). Elevated baseline hsTnT, found in 84% of patients with acute myocardial injury, was strongly associated with this outcome: odds ratio (OR), 12.08 (95% confidence interval [CI], 7.78-19.42). Logistic regression identified 6 other independent predictors for acute myocardial injury: age, sex, estimated glomerular filtration rate (eGFR) <45 mL·min -1 ·1.73 m -2 , functional capacity <4 METs or unknown, NT-proBNP ≥300 pg/mL, and estimated intraoperative blood loss. The c -statistic for the risk model was 77% (95% CI, 0.73-0.81). The net benefit of the model began at a risk threshold of 7%. CONCLUSIONS Baseline determination of cardiac biomarkers in patients at risk for MACCE shortly before intermediate- or high-risk noncardiac surgery helps identify those with the highest risk for acute myocardial injury. A baseline hsTnT ≥14 ng/L indicates the need for postoperative troponin surveillance. In patients with baseline hsTnT <14 ng/L, our 6-predictor model will identify additional patients at risk for acute myocardial injury who may also benefit from postoperative surveillance.
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Affiliation(s)
- Anna Mases
- From the Department of Anesthesiology, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Sandra Beltrán de Heredia
- From the Department of Anesthesiology, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Lluís Gallart
- From the Department of Anesthesiology, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Lorena Román
- From the Department of Anesthesiology, Hospital del Mar, Barcelona, Spain
| | - Laia Bosch
- From the Department of Anesthesiology, Hospital del Mar, Barcelona, Spain
| | - Maria Núñez
- From the Department of Anesthesiology, Hospital del Mar, Barcelona, Spain
| | - Mireia Rueda
- From the Department of Anesthesiology, Hospital del Mar, Barcelona, Spain
| | - Lluís Recasens
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Sergi Sabaté
- Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Lin Y, Zhou F, Wang X, Guo Y, Chen W. Effect of the index of cardiac electrophysiological balance on major adverse cardiovascular events in patients with diabetes complicated with coronary heart disease. PeerJ 2023; 11:e15969. [PMID: 37818331 PMCID: PMC10561639 DOI: 10.7717/peerj.15969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/06/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose To investigate the prognostic value of the index of cardio-electrophysiological balance (ICEB) and its association with major adverse cardiac events (MACE) and cardiovascular death in diabetic patients complicated with coronary heart disease. Methods A total of 920 diabetic patients were enrolled in this longitudinal study. Participants were categorized into three groups based on their ICEB levels: normal ICEB, low ICEB, and high ICEB. The primary outcome was the occurrence of MACE, and secondary outcomes included cardiovascular death, coronary heart disease (CHD), heart failure (HF), and sudden cardiac arrest (SCA). Patients were followed for a median period of 3.26 years, and the associations between ICEB levels and various outcomes were evaluated. Results Over the follow-up period, 46 (5.0%) MACE were observed in the normal ICEB group, 57 (6.2%) in the low ICEB group, and 62 (6.8%) in the high ICEB group. Elevated ICEB levels were found to be associated with a higher risk of MACE and cardiovascular death. A significant relationship between ICEB levels and the risk of MACE was observed for both genders. The risk of MACE increased with each unit increment in the ICEB index. However, the two-stage linear regression model did not outperform the single-line linear regression models in determining the threshold effect. Conclusion This study demonstrates the potential utility of ICEB, derived from a standard non-invasive ECG, as a prognostic tool for predicting MACE and cardiovascular death in diabetic patients complicated with CVD. The associations between ICEB levels and the risk of MACE highlight the importance of understanding cardiac electrophysiological imbalances and their implications in CVD.
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Affiliation(s)
- Yuan Lin
- Department of Endocrinology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Fang Zhou
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Xihui Wang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Yaju Guo
- Department of Endocrinology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Weiguo Chen
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
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Zahid JA, Orhan A, Hadi NAH, Ekeloef S, Gögenur I. Myocardial injury and long-term oncological outcomes in patients undergoing surgery for colorectal cancer. Int J Colorectal Dis 2023; 38:234. [PMID: 37725173 PMCID: PMC10509133 DOI: 10.1007/s00384-023-04528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Myocardial injury after noncardiac surgery (MINS) is associated with increased mortality and postoperative complications. In patients with colorectal cancer (CRC), postoperative complications are a risk factor for cancer recurrence and disease-free survival. This study investigates the association between MINS and long-term oncological outcomes in patients with CRC in an ERAS setting. METHODS This retrospective cohort study was conducted at Zealand University Hospital, Denmark, between June 2015 and July 2017. Patients undergoing CRC surgery were included if troponin was measured twice after surgery. Outcomes were all-cause mortality, recurrence, and disease-free survival within five years of surgery. RESULTS Among 586 patients, 42 suffered MINS. After five years, 36% of patients with MINS and 26% without MINS had died, p = 0.15. When adjusted for sex, age and UICC, the hazard ratio (aHR) for 1-year all-cause mortality, recurrence, and disease-free survival were 2.40 [0.93-6.22], 1.47 [0.19-11.29], and 2.25 [0.95-5.32] for patients with MINS compared with those without, respectively. Further adjusting for ASA status, performance status, smoking, and laparotomies, the aHR for 3- and 5-year all-cause mortality were 1.05 [0.51-2.15] and 1.11 [0.62-1.99], respectively. Similarly, the aHR for 3- and 5-year recurrence were 1.38 [0.46-4.51], and 1.49 [0.56-3.98] and for 3- and 5-year disease-free survival the aHR were 1.19 [0.63-2.23], and 1.19 [0.70-2.03]. CONCLUSION In absolute numbers, we found no difference in all-cause mortality and recurrence in patients with and without MINS. In adjusted Cox regression analyses, the hazard was increased for all-cause mortality, recurrence, and disease-free survival in patients with MINS without reaching statistical significance.
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Affiliation(s)
- Jawad Ahmad Zahid
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebækvej 1, 4600 Køge, Copenhagen, Denmark.
| | - Adile Orhan
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebækvej 1, 4600 Køge, Copenhagen, Denmark
| | - Noor Al-Huda Hadi
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebækvej 1, 4600 Køge, Copenhagen, Denmark
| | - Sarah Ekeloef
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebækvej 1, 4600 Køge, Copenhagen, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebækvej 1, 4600 Køge, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Wahlstrøm KL, Ekeloef S, Gögenur I, Münster AMB. Myocardial injury after non-cardiac surgery and per operative fibrin metabolism in patients undergoing hip-fracture surgery: an observational study. Scand J Clin Lab Invest 2023; 83:299-308. [PMID: 37584362 DOI: 10.1080/00365513.2023.2220970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 08/17/2023]
Abstract
Myocardial injury after non-cardiac surgery (MINS) is associated with a 2-3-fold increased risk of subsequent major cardiovascular events and postoperative mortality. The pathological mechanism behind MINS is not fully uncovered. We hypothesized that patients with MINS following hip fracture surgery would have an altered haemostatic balance pre- and postoperative compared with patients without MINS. This was investigated in a prospective single-centre observational study including patients consecutively. The outcomes were changes in thrombin generation, fibrinogen/fibrin turnover, tissue plasminogen activator, plasminogen activator inhibitor-1 and fibrin structure measurements in patients developing MINS and patients who did not. Outcomes were measured preoperatively and two hours postoperatively. Seventy-two patients were included whereof 26 (36%) patients developed MINS. D-dimer delta values were significantly higher in patients developing MINS than in patients who did not (p = 0.01). After adjusting for age, sex, smoking, alcohol abuse, atrial fibrillation, anticoagulant medication preoperative CRP, preoperative creatinine and duration of surgery, the association remained significant (p = 0.04). There were no significant changes in thrombin generation, in markers of fibrinogen/fibrin turnover besides D-dimer, or in fibrin structure measurements pre- and postoperatively between patients with and without MINS. As such, a relationship between the coagulative and fibrinolytic activity and MINS cannot be ruled out in patients with MINS after hip fracture surgery. Registration: The study was an observational sub-study to a multicentre randomised clinical trial registered at ClinicalTrials.gov (NCT02344797).
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Affiliation(s)
- Kirsten L Wahlstrøm
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - Sarah Ekeloef
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Denmark
| | - Anna-Marie B Münster
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry, Regional Hospital West Jutland, Holstebro, Denmark
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Kim J, Park J, Kwon JH, Lee JH, Yang K, Min JJ, Lee SC, Park SW, Lee SH. Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery. Open Heart 2023; 10:e002318. [PMID: 37620101 PMCID: PMC10450040 DOI: 10.1136/openhrt-2023-002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUNDS Myocardial injury after non-cardiac surgery (MINS) has recently been accepted as a common complication associated with increased mortality. However, little is known about the treatment of MINS. The aim of this study was to investigate an association between antiplatelet therapy and long-term mortality after MINS. METHODS From 2010 to 2019, patients with MINS, defined as having a peak high-sensitivity troponin I higher than 40 ng/L within 30 days after non-cardiac surgery, were screened at a tertiary centre. Patients were excluded if they had a history of coronary revascularisation before or during index hospitalisation. Clinical outcomes at 1 year were compared between patients with and without antiplatelet therapy at hospital discharge. The primary outcome was death, and the secondary outcome was major bleeding. RESULTS Of the 3818 eligible patients with MINS, 940 (24.6%) received antiplatelet therapy at hospital discharge. Patients with antiplatelet therapy had a significantly lower mortality at 1 year than those without antiplatelet therapy (7.5% vs 15.9%, adjusted HR 0.60, 95% CI 0.45 to 0.79, p<0.001). A risk of major bleeding at 1 year was not significantly different between the patients with and without antiplatelet therapy (6.6% vs 7.6%, adjusted HR 0.85, 95% CI 0.62 to 1.17, p=0.324). In propensity score-matched analysis of 886 pairs, patients with antiplatelet therapy had a significantly lower risk of 1-year mortality (adjusted HR 0.53, 95% CI 0.39 to 0.73, p<0.001) than those without antiplatelet therapy. CONCLUSIONS In patients with MINS, antiplatelet therapy at discharge was associated with decreased 1-year mortality.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, South Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jong Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, South Korea
| | - Kwangmo Yang
- Centers for Health Promotion, Samsung Medical Center, Seoul, South Korea
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, South Korea
| | - Sang-Chol Lee
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea
| | - Seung Woo Park
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea
| | - Seung-Hwa Lee
- Division of Cardiology, Wiltse Memorial Hospital, Suwon-si, Gyeonggi-do, South Korea
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Tveit SH, Myhre PL, Omland T. The clinical importance of high-sensitivity cardiac troponin measurements for risk prediction in non-cardiac surgery. Expert Rev Mol Diagn 2023:1-10. [PMID: 37162108 DOI: 10.1080/14737159.2023.2211267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION The global healthcare burden associated with surgery is substantial, with many patients experiencing perioperative complications. Cardiac troponin I and T measured with high-sensitivity assays are cardiac specific biomarkers that associate closely with adverse outcomes in most patient populations. Perioperative physiological stress can induce troponin release from cardiomyocytes, a condition known as perioperative myocardial injury (PMI). PMI is associated with increased risk of poor short- and long-term outcomes, and current European guidelines recommend screening for PMI in at-risk individuals undergoing non-cardiac surgery. AREAS COVERED In this review we summarize current knowledge of the prognostic attributes of cardiac troponins, as well as the challenges associated with their application as biomarkers in the perioperative phase. EXPERT OPINION Measurement of circulating levels of cardiac troponins identify individuals at increased risk of poor postoperative outcomes. Systematic screening of at-risk individuals undergoing non-cardiac surgery will result in a large proportion of patients in need of further diagnostic workup to establish the exact nature of their PMI. The lack of concrete evidence of clinical benefit and the increased cost associated with such a strategy is concerning and underscore the need for further research.
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Affiliation(s)
- Sjur H Tveit
- Department of Anesthesia, Division of Surgery, Akershus University Hospital,Lørenskog, Norway
- K.G. Jebsen Centre for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peder L Myhre
- K.G. Jebsen Centre for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Torbjørn Omland
- K.G. Jebsen Centre for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
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Wahlstrøm KL, Hansen HF, Kvist M, Burcharth J, Lykkesfeldt J, Gögenur I, Ekeloef S. Effect of Remote Ischaemic Preconditioning on Perioperative Endothelial Dysfunction in Non-Cardiac Surgery: A Randomised Clinical Trial. Cells 2023; 12:cells12060911. [PMID: 36980253 PMCID: PMC10047371 DOI: 10.3390/cells12060911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/24/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
Endothelial dysfunction result from inflammation and excessive production of reactive oxygen species as part of the surgical stress response. Remote ischemic preconditioning (RIPC) potentially exerts anti-oxidative and anti-inflammatory properties, which might stabilise the endothelial function after non-cardiac surgery. This was a single centre randomised clinical trial including 60 patients undergoing sub-acute laparoscopic cholecystectomy due to acute cholecystitis. Patients were randomised to RIPC or control. The RIPC procedure consisted of four cycles of five minutes of ischaemia and reperfusion of one upper extremity. Endothelial function was assessed as the reactive hyperaemia index (RHI) and circulating biomarkers of nitric oxide (NO) bioavailability (L-arginine, asymmetric dimethylarginine (ADMA), L-arginine/ADMA ratio, tetra- and dihydrobiopterin (BH4 and BH2), and total plasma biopterin) preoperative, 2–4 h after surgery and 24 h after surgery. RHI did not differ between the groups (p = 0.07). Neither did levels of circulating biomarkers of NO bioavailability change in response to RIPC. L-arginine and L-arginine/ADMA ratio was suppressed preoperatively and increased 24 h after surgery (p < 0.001). The BH4/BH2-ratio had a high preoperative level, decreased 2–4 h after surgery and remained low 24 h after surgery (p = 0.01). RIPC did not influence endothelial function or markers of NO bioavailability until 24 h after sub-acute laparoscopic cholecystectomy. In response to surgery, markers of NO bioavailability increased, and oxidative stress decreased. These findings support that a minimally invasive removal of the inflamed gallbladder countereffects reduced markers of NO bioavailability and increased oxidative stress caused by acute cholecystitis.
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Affiliation(s)
- Kirsten L. Wahlstrøm
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
- Correspondence:
| | - Hannah F. Hansen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
| | - Madeline Kvist
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
| | - Jakob Burcharth
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
| | - Jens Lykkesfeldt
- Section of Experimental Animal Models, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Ridebanevej 9, 1871 Frederiksberg C, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Sarah Ekeloef
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
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Hua G, Levin M, Zhang H, Xie M, McHugh T, Gupta M. Post-operative survival in head and neck cancer patients with elevated troponins. Clin Otolaryngol 2023; 48:200-205. [PMID: 36385741 DOI: 10.1111/coa.14009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/27/2022] [Accepted: 11/05/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The strenuous demands of head and neck cancer surgery (HNS) place patients at increased risk of myocardial injury. Troponin positivity (TP) post-operatively is a predictor of increased complications and mortality. The present study is the first to investigate the effects of TP on potential delays in adjuvant treatment and disease-specific survival. DESIGN, SETTING, PARTICIPANTS AND MAIN OUTCOME MEASURES All patients undergoing HNS from 2014 to 2016 had troponins measured at a single academic centre. Relevant patient data was extracted on retrospective chart review. The main outcome measures were the impact of TP on timing of adjuvant treatment and disease-specific survival. RESULTS Of 166 patients, 26 (15.6%) developed TP post-operatively. There was no significant difference between cohorts for baseline characteristics except for age. Overall and disease-specific survival for TP patients were respectively 45.9% and 57.4% at 3 years. There was no significant difference between cohorts for overall and disease-specific survival, and time to adjuvant therapy. CONCLUSION No significant association was found between TP and overall and disease-specific survival, and time to adjuvant therapy.
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Affiliation(s)
- Gordon Hua
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Marc Levin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Han Zhang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Xie
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Tobial McHugh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Gupta
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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12
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Mølgaard AK, Gasbjerg KS, Meyhoff CS, Lunn TH, Jakobsen JC, Gögenur I, Mathiesen O, Hägi-Pedersen D. Effect of Dexamethasone on Myocardial Injury After Total Knee Arthroplasty: A Substudy of the Randomized Clinical DEX-2-TKA Trial. Am J Med 2023; 136:193-199. [PMID: 36252718 DOI: 10.1016/j.amjmed.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Myocardial injury after noncardiac surgery (MINS) carries a high postoperative mortality. In this preplanned, subgroup analysis of the randomized DEX-2-TKA Trial, we investigated the effect of dexamethasone versus placebo on the concentration of cardiac troponin I and T (TnI and TnT) on the first postoperative morning after total knee arthroplasty. In addition, frequency of MINS, myocardial infarction, and major adverse cardiovascular events where evaluated. METHODS We included 290 patients who received either 24 mg of dexamethasone intravenously (given perioperatively) or placebo. Blood samples were analyzed as either TnI or T depending on trial site. RESULTS A total of 236 samples were eligible for analysis of TnI and 38 samples for TnT on the first postoperative morning. The median (IQR) TnI concentration was 4.6 ng/L (0-7.2 ng/L) in the dexamethasone group and 4.5ng/l (0-7.0 ng/L) in the placebo group (P = .96) on the first postoperative morning. The median TnT was 9 ng/L (6-11 ng/L) in the dexamethasone group and 8 ng/L (5-10 ng/L) in the placebo group (P = .68). The frequencies of MINS, myocardial infarction, and major adverse cardiovascular events were similar in the compared groups, but these analyses were underpowered. CONCLUSION We found no effect of dexamethasone on postoperative concentration of troponin I or T on the first postoperative morning after total knee arthroplasty.
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Affiliation(s)
- Asger K Mølgaard
- Research Centre of Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark.
| | - Kasper S Gasbjerg
- Research Centre of Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Troels H Lunn
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark; Center of Surgical Science, Department of Gastrointestinal Surgery, Zealand University Hospital, Køge, Denmark
| | - Ole Mathiesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark; Centre of Anaesthesiological Research, Department of Anesthesiology, Zealand University Hospital, Køge, Denmark
| | - Daniel Hägi-Pedersen
- Research Centre of Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, Næstved, Slagelse and Ringsted Hospitals, Slagelse, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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13
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M’Pembele R, Roth S, Nucaro A, Stroda A, Tenge T, Lurati Buse G, Bönner F, Scheiber D, Ballázs C, Tudorache I, Aubin H, Lichtenberg A, Huhn R, Boeken U. Postoperative high-sensitivity troponin T predicts 1-year mortality and days alive and out of hospital after orthotopic heart transplantation. Eur J Med Res 2023; 28:16. [PMID: 36624515 PMCID: PMC9827673 DOI: 10.1186/s40001-022-00978-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Orthotopic heart transplantation (HTX) is the gold standard to treat end-stage heart failure. Numerous risk stratification tools have been developed in the past years. However, their clinical utility is limited by their poor discriminative ability. High sensitivity troponin T (hsTnT) is the most specific biomarker to detect myocardial cell injury. However, its prognostic relevance after HTX is not fully elucidated. Thus, this study evaluated the predictive value of postoperative hsTnT for 1-year survival and days alive and out of hospital (DAOH) after HTX. METHODS This retrospective cohort study included patients who underwent HTX at the University Hospital Duesseldorf, Germany between 2011 and 2021. The main exposure was hsTnT concentration at 48 h after HTX. The primary endpoints were mortality and DAOH within 1 year after surgery. Receiver operating characteristic (ROC) curve analysis, logistic regression model and linear regression with adjustment for risk index for mortality prediction after cardiac transplantation (IMPACT) were performed. RESULTS Out of 231 patients screened, 212 were included into analysis (mean age 55 ± 11 years, 73% male). One-year mortality was 19.7% (40 patients) and median DAOH was 298 days (229-322). ROC analysis revealed strongest discrimination for mortality by hsTnT at 48 h after HTX [AUC = 0.79 95% CI 0.71-0.87]. According to Youden Index, the cutoff for hsTnT at 48 h and mortality was 1640 ng/l. After adjustment for IMPACT score multivariate logistic and linear regression showed independent associations between hsTnT and mortality/DAOH with odds ratio of 8.10 [95%CI 2.99-21.89] and unstandardized regression coefficient of -1.54 [95%CI -2.02 to -1.06], respectively. CONCLUSION Postoperative hsTnT might be suitable as an early prognostic marker after HTX and is independently associated with 1-year mortality and poor DAOH.
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Affiliation(s)
- René M’Pembele
- grid.411327.20000 0001 2176 9917Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Sebastian Roth
- grid.411327.20000 0001 2176 9917Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Anthony Nucaro
- grid.411327.20000 0001 2176 9917Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Alexandra Stroda
- grid.411327.20000 0001 2176 9917Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Theresa Tenge
- grid.411327.20000 0001 2176 9917Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Giovanna Lurati Buse
- grid.411327.20000 0001 2176 9917Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Florian Bönner
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Daniel Scheiber
- grid.411327.20000 0001 2176 9917Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Christina Ballázs
- grid.411327.20000 0001 2176 9917Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Igor Tudorache
- grid.411327.20000 0001 2176 9917Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Hug Aubin
- grid.411327.20000 0001 2176 9917Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Artur Lichtenberg
- grid.411327.20000 0001 2176 9917Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ragnar Huhn
- grid.411327.20000 0001 2176 9917Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany ,Department of Anesthesiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Udo Boeken
- grid.411327.20000 0001 2176 9917Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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14
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Clerico A, Zaninotto M, Aimo A, Musetti V, Perrone M, Padoan A, Dittadi R, Sandri MT, Bernardini S, Sciacovelli L, Trenti T, Malloggi L, Moretti M, Burgio MA, Manno ML, Migliardi M, Fortunato A, Plebani M. Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers. Clin Chem Lab Med 2022; 60:1525-1542. [PMID: 35858238 DOI: 10.1515/cclm-2022-0481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022]
Abstract
Major adverse cardiovascular events are frequently observed in patients undergoing major non-cardiac surgery during the peri-operative period. At this time, the possibility to predict cardiovascular events remains limited, despite the introduction of several algorithms to calculate the risk of adverse events, mainly death and major adverse cardiovascular events (MACE) based on the clinical history, risk factors (sex, age, lipid profile, serum creatinine) and non-invasive cardiac exams (electrocardiogram, echocardiogram, stress tests). The cardiac-specific biomarkers natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the peri-operative period, particularly for the identification of myocardial injury in patients undergoing major non-cardiac surgery. The prognostic information from the measurement of BNP/NT-proBNP and hs-cTn is independent and complementary to other important indicators of risk, also including ECG and imaging techniques. Elevated levels of cardiac-specific biomarkers before surgery are associated with a markedly higher risk of MACE during the peri-operative period. BNP/NT-proBNP and hs-cTn should be measured in all patients during the clinical evaluation before surgery, particularly during intermediate- or high-risk surgery, in patients aged >65 years and/or with comorbidities. Several questions remain to be assessed in dedicated clinical studies, such as how to optimize the management of patients with raised cardiac specific biomarkers before surgery, and whether a strategy based on biomarker measurement improves patient outcomes and is cost-effective.
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Affiliation(s)
- Aldo Clerico
- Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa, Italy
| | - Martina Zaninotto
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova e Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina-Università di Padova, Padova, Italy
| | - Alberto Aimo
- Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa, Italy
| | - Veronica Musetti
- Scuola Superiore Sant'Anna e Fondazione CNR-Regione Toscana G. Monasterio, Pisa, Italy
| | - Marco Perrone
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Roma, Italy
| | - Andrea Padoan
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova e Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina-Università di Padova, Padova, Italy
| | | | | | - Sergio Bernardini
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Roma, Italy
| | - Laura Sciacovelli
- Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova e Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina-Università di Padova, Padova, Italy
| | - Tommaso Trenti
- Dipartimento di Medicina di Laboratorio e Anatomia Patologica, Azienda Ospedaliera Universitaria e USL di Modena, Modena, Italy
| | - Lucia Malloggi
- Laboratorio Analisi, Azienda Ospedaliera-Universitaria di Pisa, Pisa, Italy
| | - Marco Moretti
- Medicina di Laboratorio, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | | | | | - Marco Migliardi
- Laboratorio Analisi, Ospedale Ordine Mauriziano, Torino, Italy
| | | | - Mario Plebani
- Dipartimento di Medicina di Laboratorio-DIMED, Università di Padova, Padova, Italy
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15
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Lee JH, Lee YI, Ahn J, Ryu JA. Association between High-Sensitivity Cardiac Troponin I and Clinical Prognosis of Neurosurgical and Neurocritically Ill Patients. Diagnostics (Basel) 2022; 12:diagnostics12092259. [PMID: 36140660 PMCID: PMC9497843 DOI: 10.3390/diagnostics12092259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
To investigate whether high-sensitivity troponin I (hs-TnI) elevation is associated with in-hospital mortality and major adverse cardiac events (MACEs) in neurosurgical and neurocritically ill patients. Among neurosurgical patients admitted to the intensive care unit (ICU) from January 2013 to December 2019, those whose serum hs-TnI levels were obtained within 7 days after ICU admission were included. Propensity score matching was used. Each patient with hs-TnI elevation was matched to a control patient. The primary endpoint was in-hospital mortality and the secondary outcome was MACEs. The hs-TnI elevation was shown in 848 (14.1%) of 6004 patients. After propensity score matching, 706 pairs of data were generated by 1:1 individual matching without replacement. In multivariable analysis of overall and propensity score-matched population, hs-TnI elevation was associated with in-hospital mortality (adjusted odds ratio (OR): 2.37, 95% confidence interval (CI): 1.68–3.33 and adjusted OR: 1.89, 95% CI: 1.28–2.81, respectively). In addition, hs-TnI elevation was associated with MACEs (adjusted OR: 2.73, 95% CI: 1.74–4.29 and adjusted OR: 2.64, 95% CI: 1.60–4.51, respectively). In this study, hs-TnI elevation was associated with in-hospital mortality and MACEs in neurosurgical and neurocritically ill patients.
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Affiliation(s)
- Jung Hwa Lee
- Department of Neurology, Ewha Women’s University Hospital, Ewha Women’s University College of Medicine, Seoul 07985, Korea
- Department of Critical Care Medicine, Ewha Women’s University Hospital, Ewha Women’s University College of Medicine, Seoul 07985, Korea
| | - Yun Im Lee
- Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea
| | - Joonghyun Ahn
- Statistic and Data Center, Clinical Research Institute, Samsung Medical Center, Seoul 06351, Korea
| | - Jeong-Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: ; Tel.: +82-2-3410-6399; Fax: +82-2-2148-7088
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16
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McCullagh IJ, Begum S, Patel A, Gillies MA. Perioperative blood transfusion in major abdominal cancer surgery: a multi-centre service evaluation and national survey. BJA OPEN 2022; 3:100032. [PMID: 37588576 PMCID: PMC10430868 DOI: 10.1016/j.bjao.2022.100032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/14/2022] [Indexed: 08/18/2023]
Abstract
Background Anaemia is associated with complications and death after surgery. Perioperative red-cell transfusion triggers are not well defined in patients having oncological surgery, or with cardiovascular disease. Methods We carried out a prospective multicentre cohort study and a clinician survey of UK transfusion practice in adult patients undergoing surgery for abdominal malignancy. The primary outcome was red cell transfusion. Secondary outcomes were transfusion trigger haemoglobin, incidence of complications, length of hospital stay, and acute hospital mortality. Results In this prospective cohort study, data were collected on 412 patients undergoing surgery for intrabdominal malignancy in 14 NHS hospitals. Twenty-two (5.2%) patients received preoperative, 42 (10.2%) intraoperative, and 52 (12.2%) postoperative red blood cell transfusion. The mean postoperative transfusion trigger was 75.3 g L-1, and the mean number of units of red blood cells transfused was 1.5 (standard deviation, 1.1). Seventeen (4.0%) patients had a documented postoperative troponin elevation. Five (1.2%) patients died within 30 days of surgery. In the survey, 117 clinicians submitted complete responses, of whom 62 (53%) indicated that a transfusion threshold of 70 g L-1 was appropriate: however, this decreased to six (5.1%) if there was evidence of recent cardiac ischaemia. There were 100 (86%) respondents who indicated equipoise for a trial of restrictive vs liberal transfusion, decreasing to 56% if there was coexisting cardiovascular disease. Conclusions Many patients having oncological surgery receive red cell transfusion, the majority being given postoperatively. Restrictive transfusion practice is generally followed; however, variability exists especially in cardiovascular disease. Equipoise exists for a study of transfusion thresholds in this group.
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Affiliation(s)
| | - Salma Begum
- The Royal London Hospital, Whitechapel Road, London, UK
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17
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Postoperative myocardial injury and platelet reactivity in patients undergoing vascular surgery: The platelet reactivity and postoperative myocardial injury after major vascular surgery (PROMISE) study. Thromb Res 2022; 218:177-185. [PMID: 36057168 DOI: 10.1016/j.thromres.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postoperative myocardial injury (PMI) after major vascular surgery, detected by elevated cardiac troponin (cTn), has been associated with morbidity and mortality. It is unclear whether the pathophysiology of PMI is determined by increased platelet activity. OBJECTIVE To examine the relationship between platelet activation (P-selectin expression) and PMI in patients undergoing elective open abdominal aortic surgery. METHODS This prospective, single-centre, observational, cohort study included 33 patients undergoing elective open abdominal aortic surgery between March 2018 and April 2021. Patients were routinely treated with aspirin. Unstimulated platelet activation was measured by platelet bound P-selectin expression (range 0-100 %). Explorative coagulation measurements were: stimulated platelet aggregation measured with the VerifyNow® assay (aspirin cartridge), with the Multiplate® analyzer (ASPI, ADP and TRAP) and stimulated coagulation status evaluated by the TEG® Hemostasis Analyzer System (global hemostasis cartridge). The primary outcome was cTn release assessed by the fifth generation high-sensitive cTn assay. Multivariable generalized linear mixed models were used to evaluate the association between platelet function and cTn concentrations over time. RESULTS Ten patients (30.3 %) developed PMI. Increased P-selectin expression directly after surgery was associated with the cTn concentrations over 48 h (β = 1.39 (1.1-1.75), P = 0.0064). No association was found between P-selectin measured later after surgery (at 24 h or 48 h) and cTn concentrations. Furthermore, there was no association between the explorative coagulation parameters and cTn release. CONCLUSION Platelet reactivity, assessed by P-selectin expression measured directly after surgery is associated with PMI, assessed by elevated cTn concentrations in the early postoperative period in patients undergoing elective open abdominal aortic surgery.
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18
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Andrei S, Tran-Dinh A, Boutten A, Asssadi M, Tashk P, Castier Y, Popescu BA, Bunel V, Tanaka S, Montravers P, Augustin P. The Perioperative Kinetics Profile of Troponin I in Lung Transplantation - A Pilot Observational Study. J Cardiothorac Vasc Anesth 2022; 36:2842-2845. [PMID: 35525702 DOI: 10.1053/j.jvca.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Stefan Andrei
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France.
| | - Alexy Tran-Dinh
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France; Unité INSERM UMR 1148, CHU Bichat-Claude Bernard, Paris, France
| | - Anne Boutten
- Laboratoire de biochimie, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Maksud Asssadi
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Parvine Tashk
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Yves Castier
- Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Bogdan Alexandru Popescu
- Department of Cardiology, CC Iliescu Emergency Institute for Cardiovascular Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Vincent Bunel
- Service de Pneumologie, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Sébastien Tanaka
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
| | - Philippe Montravers
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France; Unité INSERM UMR 1152, UFR de Médecine Xavier Bichat, Paris, France
| | - Pascal Augustin
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Sorbonne Universités, APHP, Paris, France
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Chen N, Li R, Wang E, Hu D, Tang Z. [Outcomes of patients experiencing cardiovascular adverse events within 1 year following craniotomy for intracranial aneurysm clipping: a retrospective cohort study]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1095-1099. [PMID: 35869776 DOI: 10.12122/j.issn.1673-4254.2022.07.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the impact of postoperative serious cardiovascular adverse events (CAE) on outcomes of patients undergoing craniotomy for intracranial aneurysm clipping. METHODS This retrospective cohort study was conducted among the patients undergoing craniotomy for intracranial aneurysm clipping during the period from December, 2016 to December, 2017, who were divided into CAE group and non-CAE group according to the occurrence of Clavien-Dindo grade ≥II CAEs after the surgery. The perioperative clinical characteristics of the patients, complications and neurological functions during hospitalization, and mortality and neurological functions at 1 year postoperatively were evaluated. The primary outcome was mortality within 1 year after the surgery. The secondary outcomes were Glasgow outcome scale (GOS) score at 1 year, lengths of postoperative hospital and intensive care unit (ICU) stay, and Glasgow coma scale (GCS) score at discharge. RESULTS A total of 361 patients were enrolled in the final analysis, including 20 (5.5%) patients in CAE group and 341 in the non-CAE group. No significant differences were found in the patients' demographic characteristics, clinical history, or other postoperative adverse events between the two groups. The 1-year mortality was significantly higher in CAE group than in the non-CAE group (20.0% vs 5.6%, P=0.01). Logistics regression analysis showed that when adjusted for age, gender, emergency hospitalization, subarachnoid hemorrhage, volume of bleeding, duration of operation, aneurysm location, and preoperative history of cardiovascular disease, postoperative CAEs of Clavien-Dindo grade≥II was independently correlated with 1-year mortality rate of the patients with an adjusted odds ratio of 3.670 (95% CI: 1.037-12.992, P=0.04). The patients with CEA also had a lower GOS score at 1 year after surgery than those without CEA (P=0.002). No significant differences were found in the occurrence of other adverse events, postoperative hospital stay, ICU stay, or GCS scores at discharge between the two groups (P > 0.05). CONCLUSION Postoperative CAEs may be a risk factor for increased 1-year mortality and disability in patients undergoing craniotomy for intracranial aneurysms.
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Affiliation(s)
- N Chen
- Department of Anesthesiology, Xiangya Hospital of Central South University, Changsha 410008, China
| | - R Li
- Department of Anesthesiology, Hunan Provincial People's Hospital, Changsha 410005, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital of Central South University, Changsha 410008, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China
| | - D Hu
- School of Life Sciences, Central South University, Changsha 410008, China
| | - Z Tang
- Department of Anesthesiology, Xiangya Hospital of Central South University, Changsha 410008, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha 410008, China
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20
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Kvarda P, Puelacher C, Clauss M, Kuehl R, Gerhard H, Mueller C, Morgenstern M. Perioperative myocardial injury and mortality after revision surgery for orthopaedic device-related infection. Bone Joint J 2022; 104-B:696-702. [PMID: 35638215 DOI: 10.1302/0301-620x.104b6.bjj-2021-1486.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Periprosthetic joint infections (PJIs) and fracture-related infections (FRIs) are associated with a significant risk of adverse events. However, there is a paucity of data on cardiac complications following revision surgery for PJI and FRI and how they impact overall mortality. Therefore, this study aimed to investigate the risk of perioperative myocardial injury (PMI) and mortality in this patient cohort. METHODS We prospectively included consecutive patients at high cardiovascular risk (defined as age ≥ 45 years with pre-existing coronary, peripheral, or cerebrovascular artery disease, or any patient aged ≥ 65 years, plus a postoperative hospital stay of > 24 hours) undergoing septic or aseptic major orthopaedic surgery between July 2014 and October 2016. All patients received a systematic screening to reliably detect PMI, using serial measurements of high-sensitivity cardiac troponin T. All-cause mortality was assessed at one year. Multivariable logistic regression models were applied to compare incidence of PMI and mortality between patients undergoing septic revision surgery for PJI or FRI, and patients receiving aseptic major bone and joint surgery. RESULTS In total, 911 consecutive patients were included. The overall perioperative myocardial injury (PMI) rate was 15.4% (n = 140). Septic revision surgery for PJI was associated with a significantly higher PMI rate (43.8% (14/32) vs 14.5% (57/393); p = 0.001) and one-year mortality rate (18.6% (6/32) vs 7.4% (29/393); p = 0.038) compared to aseptic revision or primary arthroplasty. The association with PMI persisted in multivariable analysis with an adjusted odds ratio (aOR) of 4.7 (95% confidence interval (CI) 2.1 to 10.7; p < 0.001), but was not statistically significant for one-year mortality (aOR 1.9 (95% CI 0.7 to 5.4; p = 0.240). PMI rate (15.2% (5/33) vs 14.1% (64/453)) and one-year mortality (15.2% (5/33) vs 9.1% (41/453)) after FRI revision surgery were comparable to aseptic long-bone fracture surgery. CONCLUSION Patients undergoing revision surgery for PJI were at a risk of PMI and death compared to those undergoing aseptic arthroplasty surgery. Screening for PMI and treatment in specialized multidisciplinary units should be considered in major bone and joint infections. Cite this article: Bone Joint J 2022;104-B(6):696-702.
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Affiliation(s)
- Peter Kvarda
- Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland.,Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Christian Puelacher
- University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland.,Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Richard Kuehl
- University of Basel, Basel, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Hatice Gerhard
- University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Christian Mueller
- University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Mario Morgenstern
- Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland.,Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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21
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Gao L, Chen L, He J, Wang B, Liu C, Wang R, Fan L, Cheng R. Perioperative Myocardial Injury/Infarction After Non-cardiac Surgery in Elderly Patients. Front Cardiovasc Med 2022; 9:910879. [PMID: 35665266 PMCID: PMC9160386 DOI: 10.3389/fcvm.2022.910879] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/28/2022] [Indexed: 12/15/2022] Open
Abstract
At present, we have entered an aging society. Many diseases suffered by the elderly, such as malignant tumors, cardiovascular diseases, fractures, surgical emergencies and so on, need surgical intervention. With the improvement of Geriatrics, surgical minimally invasive technology and anesthesia level, more and more elderly patients can safely undergo surgery. Elderly surgical patients are often complicated with a variety of chronic diseases, and the risk of postoperative myocardial injury/infarction (PMI) is high. PMI is considered to be the increase of cardiac troponin caused by perioperative ischemia, which mostly occurs during operation or within 30 days after operation, which can increase the risk of short-term and long-term death. Therefore, it is suggested to screen troponin in elderly patients during perioperative period, timely identify patients with postoperative myocardial injury and give appropriate treatment, so as to improve the prognosis. The pathophysiological mechanism of PMI is mainly due to the increase of myocardial oxygen consumption and / the decrease of myocardial oxygen supply. Preoperative and postoperative risk factors of myocardial injury can be induced by mismatch of preoperative and postoperative oxygen supply. The treatment strategy should first control the risk factors and use the drugs recommended in the guidelines for treatment. Application of cardiovascular drugs, such as antiplatelet β- Receptor blockers, statins and angiotensin converting enzyme inhibitors can effectively improve postoperative myocardial ischemia. However, the risk of perioperative bleeding should be fully considered before using antiplatelet and anticoagulant drugs. This review is intended to describe the epidemiology, diagnosis, pathophysiology, risk factors, prognosis and treatment of postoperative myocardial infarction /injury.
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Affiliation(s)
- Linggen Gao
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Lei Chen
- Department of Thoracic Surgery, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Jing He
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Bin Wang
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Chaoyang Liu
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Rong Wang
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Li Fan
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
- *Correspondence: Li Fan
| | - Rui Cheng
- Department of Comprehensive Surgery, General Hospital of Chinese People's Liberation Army and National Clinical Research Center for Geriatric Disease, Beijing, China
- Rui Cheng
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22
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Natriuretic Peptides and Troponins to Predict Cardiovascular Events in Patients Undergoing Major Non-Cardiac Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095182. [PMID: 35564577 PMCID: PMC9103429 DOI: 10.3390/ijerph19095182] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
Patients undergoing major surgery have a substantial risk of cardiovascular events during the perioperative period. Despite the introduction of several risk scores based on medical history, classical risk factors and non-invasive cardiac tests, the possibility of predicting cardiovascular events in patients undergoing non-cardiac surgery remains limited. The cardiac-specific biomarkers, natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the perioperative period. This review paper aims to discuss the value of preoperative levels and perioperative changes in cardiac-specific biomarkers to predict adverse outcomes in patients undergoing major non-cardiac surgery. Based on several prospective observational studies and six meta-analyses, some guidelines recommended the measurement of NPs to refine perioperative cardiac risk estimation in patients undergoing non-cardiac surgery. More recently, several studies reported a higher mortality in surgical patients presenting an elevation in high-sensitivity cardiac troponin T and I, especially in elderly patients or those with comorbidities. This evidence should be considered in future international guidelines on the evaluation of perioperative risk in patients undergoing major non-cardiac surgery.
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23
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Buse GL, Matot I. Pro-Con Debate: Cardiac Troponin Measurement as Part of Routine Follow-up of Myocardial Damage Following Noncardiac Surgery. Anesth Analg 2022; 134:257-265. [PMID: 35030121 DOI: 10.1213/ane.0000000000005714] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Elevated troponin levels within 3 days of surgery, independent of the presence of symptoms, are strongly linked to increased risk of short- and long-term morbidity and mortality. However, the value of screening with troponin measurements is controversial. The Canadian Cardiovascular Society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery recommends measuring daily troponin for 48 to 72 hours after surgery in high-risk patients. Nevertheless, others doubt this recommendation, in part because postoperative elevated levels of troponin describe very little in terms of disease or event-specific pathogenesis and etiology, and thus, tailoring an intervention remains a challenge. This Pro-Con debate offers evidence-based data to stimulate physician understanding of daily practice and its significance in this matter, and assist in determining whether to use (Pro) or not to use (Con) this surveillance.
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Affiliation(s)
- Giovanna Lurati Buse
- From the Anesthesiology Department, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Idit Matot
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel Aviv Medical School, Tel Aviv University, Tel-Aviv, Israel
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24
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Wang L, Cai M, Li X, Deng X, Xue Q, Zhou L, Yang M. Association of Acute Perioperative Myocardial Injury With All-Cause Mortality Within 90 Days After Hip Fracture Repair in the Elderly: A Prospective Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593211070129. [PMID: 35047229 PMCID: PMC8761883 DOI: 10.1177/21514593211070129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction It remains unclear whether acute perioperative myocardial injury (APMI) increases mortality in the elderly. This study aimed to investigate APMI’s association with mortality within 90 days after hip fracture repair in elderly patients. Materials and Methods This prospective study enrolled elderly patients admitted to the department of Traumatology and Orthopaedics in XXX Hospital, who underwent surgery in 2018–2019 with a 90-day follow-up. According to survival status within 90 days, survival and death groups were constituted. Clinical, demographic, and laboratory indicators and 90-day mortality post-surgery were recorded. APMI’s association with 90-day mortality post-surgery was analyzed by logistic regression. Results Totally 248 participants were enrolled, including 224 and 24 in the survival and death groups, respectively, for a mortality rate of 9.7%. Compared with surviving individuals, the death group was older [81 (75–86) vs 87 (82–89) years], and had higher incidence rates of APMI (24.6% vs 58.3%), intertrochanteric fractures (41.1% vs 62.5%), preoperative atrial fibrillation (8.9% vs 29.2%), and dementia (73.7% vs 95.8%) (all P<.05). They also showed higher pre-injury frail scale scores [1 (0–2) vs 3 (1–4)] and Nottingham hip fracture scores (NHFSs) [4 (4–5) vs 6.5 (5–7)], lower Glomerular filtration [62 (46.1–78.6) vs 44.37 (35–61.92) ml/min], and reduced odds of glomerular filtration rate <60 mL/min (75.0% vs 46.9%) (all P < .05). APMI (OR = 3.294, 95% CI: 1.217–8.913) and NHFS (OR = 2.089, 95% CI: 1.353–3.225) independently predicted 90-day mortality post-surgery (all P<.05). Conclusions APMI is associated with increased mortality risk within 90 days after hip fracture repair in elderly patients.
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Affiliation(s)
- Lei Wang
- Department of Geratology, Beijing Jishuitan Hospital, Beijing, China
| | - Meng Cai
- Department of Geratology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoying Li
- Department of Geratology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaohui Deng
- Department of Geratology, Beijing Jishuitan Hospital, Beijing, China
| | - Qiang Xue
- Department of Geratology, Beijing Jishuitan Hospital, Beijing, China
| | - Li Zhou
- Department of Geratology, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
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25
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Saka E, Canbaz M, Abdullah T, Dinc T, Polat O, Sabanci PA, Akinci IO, Tugrul KM, Ali A. Perioperative myocardial injury after elective neurosurgery: incidence, risk factors, and effects on mortality. Neurosurg Rev 2022; 45:2151-2159. [PMID: 35018524 DOI: 10.1007/s10143-021-01722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/20/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Perioperative myocardial injury is an important reason of mortality and morbidity after neurosurgery. It usually is missed due to its asymptomatic character. In the present study, we investigated myocardial injury after noncardiac surgery (MINS) incidence, the risk factor for MINS, and association of MINS with 30-day mortality in neurosurgery patients. Patients with cardiac risk who underwent elective neurosurgery were enrolled to present prospective cohort study. The patients' demographics, comorbidities, medications used, medical history, and type of operation were recorded. The high-sensitivity cardiac troponin (hs-cTn) levels of the patients were measured 12, 24, and 48 h after surgery. The patients were considered MINS-positive if at least one of their postoperative hs-cTn measurement values was ≥ 14 ng/l. All the patients were followed up for 30 days after surgery for evaluation of their outcomes, including total mortality, mortality due to cardiovascular cause, and major cardiac events. A total of 312 patients completed the study and 64 (20.5%) of them was MINS-positive. Long antiplatelet or anticoagulant drug cessation time (OR: 4.9, 95% CI: 2.1-9.4) was found the most prominent risk factor for MINS occurrence. The total mortality rate was 2.4% and 6.2% in patients MINS-negative and MINS-positive, respectively (p = 0.112). The mortality rate due to cardiovascular reasons (0.8% for without MINS, 4.7 for with MINS, and p = 0.026) and incidence of the major cardiac events (4% for without MINS, 10.9 for with MINS, and p = 0.026) were significantly higher in patients with MINS. MINS is a common problem after neurosurgery, and high postoperative hs-cTn level is associated with mortality and morbidity.
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Affiliation(s)
- Esra Saka
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Turgut Özal cad, Istanbul, Turkey
| | - Mert Canbaz
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Turgut Özal cad, Istanbul, Turkey
| | - Taner Abdullah
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Turgut Özal cad, Istanbul, Turkey
| | - Tugce Dinc
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Turgut Özal cad, Istanbul, Turkey
| | - Ozlem Polat
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Turgut Özal cad, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ibrahim Ozkan Akinci
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Turgut Özal cad, Istanbul, Turkey
| | - Kamil Mehmet Tugrul
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Turgut Özal cad, Istanbul, Turkey
| | - Achmet Ali
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Turgut Özal cad, Istanbul, Turkey. .,İ.Ü. İstanbul Tıp Fakültesi Anesteziyoloji A.D., Turgut Özal cad, İstanbul, Türkiye.
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26
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Vernooij LM, van Klei WA, Moons KG, Takada T, van Waes J, Damen JA. The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery. Cochrane Database Syst Rev 2021; 12:CD013139. [PMID: 34931303 PMCID: PMC8689147 DOI: 10.1002/14651858.cd013139.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Revised Cardiac Risk Index (RCRI) is a widely acknowledged prognostic model to estimate preoperatively the probability of developing in-hospital major adverse cardiac events (MACE) in patients undergoing noncardiac surgery. However, the RCRI does not always make accurate predictions, so various studies have investigated whether biomarkers added to or compared with the RCRI could improve this. OBJECTIVES Primary: To investigate the added predictive value of biomarkers to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Secondary: To investigate the prognostic value of biomarkers compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Tertiary: To investigate the prognostic value of other prediction models compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. SEARCH METHODS We searched MEDLINE and Embase from 1 January 1999 (the year that the RCRI was published) until 25 June 2020. We also searched ISI Web of Science and SCOPUS for articles referring to the original RCRI development study in that period. SELECTION CRITERIA We included studies among adults who underwent noncardiac surgery, reporting on (external) validation of the RCRI and: - the addition of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of the RCRI to other models. Besides MACE, all other adverse outcomes were considered for inclusion. DATA COLLECTION AND ANALYSIS We developed a data extraction form based on the CHARMS checklist. Independent pairs of authors screened references, extracted data and assessed risk of bias and concerns regarding applicability according to PROBAST. For biomarkers and prediction models that were added or compared to the RCRI in ≥ 3 different articles, we described study characteristics and findings in further detail. We did not apply GRADE as no guidance is available for prognostic model reviews. MAIN RESULTS We screened 3960 records and included 107 articles. Over all objectives we rated risk of bias as high in ≥ 1 domain in 90% of included studies, particularly in the analysis domain. Statistical pooling or meta-analysis of reported results was impossible due to heterogeneity in various aspects: outcomes used, scale by which the biomarker was added/compared to the RCRI, prediction horizons and studied populations. Added predictive value of biomarkers to the RCRI Fifty-one studies reported on the added value of biomarkers to the RCRI. Sixty-nine different predictors were identified derived from blood (29%), imaging (33%) or other sources (38%). Addition of NT-proBNP, troponin or their combination improved the RCRI for predicting MACE (median delta c-statistics: 0.08, 0.14 and 0.12 for NT-proBNP, troponin and their combination, respectively). The median total net reclassification index (NRI) was 0.16 and 0.74 after addition of troponin and NT-proBNP to the RCRI, respectively. Calibration was not reported. To predict myocardial infarction, the median delta c-statistic when NT-proBNP was added to the RCRI was 0.09, and 0.06 for prediction of all-cause mortality and MACE combined. For BNP and copeptin, data were not sufficient to provide results on their added predictive performance, for any of the outcomes. Comparison of the predictive value of biomarkers to the RCRI Fifty-one studies assessed the predictive performance of biomarkers alone compared to the RCRI. We identified 60 unique predictors derived from blood (38%), imaging (30%) or other sources, such as the American Society of Anesthesiologists (ASA) classification (32%). Predictions were similar between the ASA classification and the RCRI for all studied outcomes. In studies different from those identified in objective 1, the median delta c-statistic was 0.15 and 0.12 in favour of BNP and NT-proBNP alone, respectively, when compared to the RCRI, for the prediction of MACE. For C-reactive protein, the predictive performance was similar to the RCRI. For other biomarkers and outcomes, data were insufficient to provide summary results. One study reported on calibration and none on reclassification. Comparison of the predictive value of other prognostic models to the RCRI Fifty-two articles compared the predictive ability of the RCRI to other prognostic models. Of these, 42% developed a new prediction model, 22% updated the RCRI, or another prediction model, and 37% validated an existing prediction model. None of the other prediction models showed better performance in predicting MACE than the RCRI. To predict myocardial infarction and cardiac arrest, ACS-NSQIP-MICA had a higher median delta c-statistic of 0.11 compared to the RCRI. To predict all-cause mortality, the median delta c-statistic was 0.15 higher in favour of ACS-NSQIP-SRS compared to the RCRI. Predictive performance was not better for CHADS2, CHA2DS2-VASc, R2CHADS2, Goldman index, Detsky index or VSG-CRI compared to the RCRI for any of the outcomes. Calibration and reclassification were reported in only one and three studies, respectively. AUTHORS' CONCLUSIONS Studies included in this review suggest that the predictive performance of the RCRI in predicting MACE is improved when NT-proBNP, troponin or their combination are added. Other studies indicate that BNP and NT-proBNP, when used in isolation, may even have a higher discriminative performance than the RCRI. There was insufficient evidence of a difference between the predictive accuracy of the RCRI and other prediction models in predicting MACE. However, ACS-NSQIP-MICA and ACS-NSQIP-SRS outperformed the RCRI in predicting myocardial infarction and cardiac arrest combined, and all-cause mortality, respectively. Nevertheless, the results cannot be interpreted as conclusive due to high risks of bias in a majority of papers, and pooling was impossible due to heterogeneity in outcomes, prediction horizons, biomarkers and studied populations. Future research on the added prognostic value of biomarkers to existing prediction models should focus on biomarkers with good predictive accuracy in other settings (e.g. diagnosis of myocardial infarction) and identification of biomarkers from omics data. They should be compared to novel biomarkers with so far insufficient evidence compared to established ones, including NT-proBNP or troponins. Adherence to recent guidance for prediction model studies (e.g. TRIPOD; PROBAST) and use of standardised outcome definitions in primary studies is highly recommended to facilitate systematic review and meta-analyses in the future.
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Affiliation(s)
- Lisette M Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wilton A van Klei
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Anesthesiologist and R. Fraser Elliott Chair in Cardiac Anesthesia, Department of Anesthesia and Pain Management Toronto General Hospital, University Health Network and Professor, Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Judith van Waes
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Johanna Aag Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Zahid JA, Orhan A, Ekeloef S, Gögenur I. Myocardial Injury After Colorectal Cancer Surgery and Postoperative 90-Day Mortality and Morbidity: A Retrospective Cohort Study. Dis Colon Rectum 2021; 64:1531-1541. [PMID: 34508013 DOI: 10.1097/dcr.0000000000002061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Myocardial injury after noncardiac surgery is a strong predictor of 30-day mortality and morbidity. OBJECTIVE The purpose of this study was to examine the incidence of myocardial injury in patients undergoing colorectal cancer surgery in an enhanced recovery after surgery protocol and its association with 90-day mortality and morbidity. DESIGN This is a retrospective cohort study. SETTING This study was conducted at Zealand University Hospital, Denmark, between June 2015 and July 2017. PATIENTS Adult patients undergoing colorectal cancer surgery were included if troponin was measured at least twice during the first 7 days after surgery. The patients were followed for 90 days. MAIN OUTCOME MEASURES Myocardial injury was defined as an elevated troponin I measurement (>45 ng/L) without evidence of a nonischemic origin causing the elevation. Ninety-day mortality and complications were assessed. RESULTS A total of 586 patients were included of which 42 were diagnosed with myocardial injury. Thirteen patients (2%) died within 90 days of surgery. There was no significant difference in 90-day mortality between patients with and without myocardial injury (5% (2/42) versus 2% (11/544); p = 0.24). We found a higher incidence of postoperative complications within 90 days of surgery in the myocardial injury group than in the nonmyocardial injury group (43% (18/42) versus 20% (107/544); p < 0.01). We found a significant difference between the myocardial injury group and nonmyocardial injury group in terms of medical complications (33% (14/42) versus 9% (50/544); p < 0.01) but not surgical complications (19% (8/42) versus 16% (85/544); p = 0.56). Myocardial injury was an independent predictor of postoperative complications within 90 days of surgery (adjusted OR, 2.69; 95% CI, 1.31-5.55). LIMITATIONS This study was limited by its retrospective design. CONCLUSION Myocardial injury occurs frequently in patients undergoing colorectal cancer surgery in an enhanced recovery after surgery protocol. Patients with myocardial injury did not have a significantly higher 90-day mortality but had higher risk of 90-day postoperative complications than patients without myocardial injury. Future research should examine the prevention and treatment of myocardial injury. See Video Abstract at http://links.lww.com/DCR/B692. LESIN MIOCRDICA DESPUS DE LA CIRUGA DE CNCER COLORRECTAL Y MORTALIDAD Y MORBILIDAD POSOPERATORIAS A LOS DAS UN ESTUDIO DE COHORTE RETROSPECTIVE ANTECEDENTES:La lesión del miocardio después de una cirugía no cardíaca es un fuerte predictor de mortalidad y morbilidad a los 30 días.OBJETIVO:El propósito fue examinar la incidencia de lesión miocárdica en pacientes sometidos a cirugía de cáncer colorrectal en un protocolo de recuperación mejorada después de la cirugía y su asociación con la mortalidad y morbilidad a los 90 días.DISEÑO:Estudio de cohorte retrospectivo.AJUSTE:Realizado en el Hospital Universitario de Zelanda, Dinamarca, entre junio de 2015 y julio de 2017.PACIENTES:Se incluyeron pacientes adultos sometidos a cirugía de cáncer colorrectal, si la troponina se midió al menos dos veces durante los primeros siete días después de la cirugía. Los pacientes fueron seguidos durante 90 días.PRINCIPALES MEDIDAS DE RESULTADO:La lesión miocárdica se definió como una medición de troponina I elevada (> 45 ng / l) sin evidencia de una etiología no isquémica que causara la elevación. Se evaluaron la mortalidad y las complicaciones a los noventa días.RESULTADOS:Se incluyeron un total de 586 pacientes, de los cuales 42 fueron diagnosticados de lesión miocárdica. Trece pacientes (2%) murieron dentro de los 90 días posteriores a la cirugía. No hubo diferencias significativas en la mortalidad a 90 días entre los pacientes con y sin lesión del miocardio, 5% [2/42] versus 2% [11/544], p = 0,24. Encontramos una mayor incidencia de complicaciones posoperatorias dentro de los 90 días de la cirugía en el grupo de lesión miocárdica en comparación con el grupo de lesión no miocárdica, 43% [18/42] versus 20% [107/544], p <0,01. Encontramos una diferencia significativa entre el grupo de lesión miocárdica y el grupo de lesión no miocárdica en términos de complicaciones médicas (33% [14/42] versus 9% [50/544]; p <0,01) pero no complicaciones quirúrgicas (19% [8/42] versus 16% [85/544]; p = 0,56). La lesión miocárdica fue un predictor independiente de complicaciones posoperatorias dentro de los 90 días posteriores a la cirugía (razón de probabilidades ajustada: 2,69; intervalo de confianza del 95%: 1,31 - 5,55).LIMITACIONES:Limitado por su diseño retrospectivo.CONCLUSIÓN:La lesión del miocardio ocurre con frecuencia en pacientes sometidos a cirugía de cáncer colorrectal en un protocolo de recuperación mejorada después de la cirugía. Los pacientes con lesión miocárdica no tuvieron una mortalidad significativamente mayor a los 90 días, pero tuvieron un mayor riesgo de complicaciones posoperatorias a los 90 días en comparación con los pacientes sin lesión miocárdica. Las investigaciones futuras deben examinar la prevención y el tratamiento de la lesión miocárdica. Consulte Video Resumen en http://links.lww.com/DCR/B692.
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Affiliation(s)
- Jawad A Zahid
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, University of Copenhagen
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Andrei S, Kantor E, Asssadi M, Boutten A, Pellenc Q, Jebrak G, Godement M, Abbas S, Atchade E, Tran-Dinh A, Robert-Mercier T, Valeanu L, Longrois D, Montravers P, Augustin P. The Prognostic Role of Early Postoperative Troponin I in Lung Transplantation-A Retrospective 7-Year Analysis. J Cardiothorac Vasc Anesth 2021; 36:2328-2334. [PMID: 34911638 DOI: 10.1053/j.jvca.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Postoperative cardiac troponin I concentration is predictive of worsened outcomes in cardiac surgery. Lung transplantation (LT) surgery shares common features with cardiac surgery, but postoperative troponin has yet to be investigated. The authors aimed to evaluate the association between early postoperative troponin concentration and the 1-year mortality after transplantation. DESIGN A retrospective, observational, single-center study. SETTING At a tertiary care, university hospital. PARTICIPANTS Patients who underwent lung transplantation from January 2011 to December 2017 INTERVENTIONS: For each patient, preoperative, intraoperative, and postoperative data were collected, as well as the troponin I measurement at the moment of postoperative intensive care unit admission. MEASUREMENTS AND MAIN RESULTS Two hundred twenty LT procedures were analyzed. Troponin I was elevated in all LT patients, with a median of 3.82 ng/mL-1 (2-6.42) ng/mL-1 significantly higher in non-survivors than in survivors with 5.39 (2.88-7.44) v 3.50 ng/mL (1.74-5.76), p = 0.005. In the multivariate analysis, the authors found that only the Simplified Acute Physiology Score II score (hazard ratio [HR] 1.03; 95% confidence interval [CI] [1.001; 1.05]; p = 0.007) and the need to maintain extracorporeal life support at the end of surgery (HR 2.54; 95% CI [1.36; 4.73]; p = 0.003) were independently associated with the 1-year mortality. The multiple linear regression model found that troponin levels were associated with the need for extracorporeal life support (ECLS) (p = 0.014), the amount of transfused packed red blood cells (p = 0.008), and bilateral LT (p < 0.001). CONCLUSION Early postoperative troponin serum levels were not independently associated with 1-year mortality. Early postoperative troponin I levels were correlated to bilateral LT, the need for ECLS, and intraoperative blood transfusion.
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Affiliation(s)
- Stefan Andrei
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France.
| | - Elie Kantor
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Maksud Asssadi
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Anne Boutten
- Laboratoire de biochimie, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Quentin Pellenc
- Service de Chirurgie Thoracique et Vasculaire, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Gilles Jebrak
- Service de Pneumologie, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Mathieu Godement
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Samia Abbas
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Enora Atchade
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Alexy Tran-Dinh
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France; Unité INSERM UMR 1148, CHU Bichat-Claude Bernard, Paris, France
| | - Tiphaine Robert-Mercier
- Laboratoire de biochimie, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Liana Valeanu
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
| | - Dan Longrois
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France; Unité INSERM UMR 1148, CHU Bichat-Claude Bernard, Paris, France
| | - Philippe Montravers
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France; Unité INSERM UMR 1152, UFR de Médecine Xavier Bichat, Paris, France
| | - Pascal Augustin
- Département d'Anesthésie Réanimation, CHU Bichat-Claude Bernard, Université Paris-Diderot, Paris, France
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Smith TG, Buckey JC. Anaesthetists and aerospace medicine in a new era of human spaceflight. Anaesthesia 2021; 77:384-388. [PMID: 34496029 DOI: 10.1111/anae.15580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 01/31/2023]
Affiliation(s)
- T G Smith
- Centre for Human and Applied Physiological Sciences, King's College London, UK.,Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J C Buckey
- Space Medicine Innovations Laboratory, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Puelacher C, Bollen Pinto B, Mills NL, Duceppe E, Popova E, Duma A, Nagele P, Omland T, Hammerer-Lercher A, Lurati Buse G. Expert consensus on peri-operative myocardial injury screening in noncardiac surgery: A literature review. Eur J Anaesthesiol 2021; 38:600-608. [PMID: 33653981 DOI: 10.1097/eja.0000000000001486] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Peri-operative myocardial injury, detected by dynamic and elevated cardiac troponin (cTn) concentrations, is a common complication of noncardiac surgery that is strongly associated with 30-day mortality. Although active screening for peri-operative myocardial injury has been suggested in recent guidelines, clinical implementation remains tentative due to a lack of examples on how to tackle such an interdisciplinary project at a local level. Moreover, consensus on which assay and cTn cut-off values should be used has not yet been reached, and guidance on whom to screen is lacking. In this article, we aim to summarise local examples of successfully implemented cTn screening practices and review the current literature in order to provide information and suggestions for patient selection, organisation of a screening programme, caveats and a potential management pathway.
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Affiliation(s)
- Christian Puelacher
- From the Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital of Basel, University of Basel; Department of Internal Medicine, University Hospital Basel, University Basel, Basel (CP), Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland (CP, BBP), Geneva Perioperative Basic, Translational and Clinical Research Group (BB-P), BHF Centre for Cardiovascular Science and Usher Institute, University of Edinburgh, Edinburgh, UK (NLM), Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada (ED), Iberoamerican Cochrane Centre, Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain (EP), Department of Anaesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria (AD), Departments of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, USA (PN), Department of Cardiology, Division of Medicine, Akershus University Hospital and University of Oslo, Oslo, Norway (TO), Institute of Laboratory Medicine, County Hospital Aarau, Aarau, Switzerland (A-HL), Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany (GLB)
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Vogelsang RP, Søby JH, Tolstrup MB, Burcharth J, Ekeløf S, Gögenur I. Associations between malignancy and cardiovascular complications following emergency laparotomy - A retrospective cohort study. Surg Oncol 2021; 38:101591. [PMID: 33991941 DOI: 10.1016/j.suronc.2021.101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Systemic inflammation in patients with malignant disease has been associated with increased risk of cardiovascular events. The pro-inflammatory perturbations following surgical trauma may further promote adverse perioperative cardiovascular events and increase the risk of patients with cancer undergoing major surgery. Our objective was to estimate the association between malignant disease and postoperative cardiovascular complications. Secondarily, we aimed to identify risk factors for postoperative cardiovascular complications. METHODS We conducted a retrospective cohort study of all patients ≥18 years undergoing emergency laparotomy between 2010 and 2016 at Department of Surgery, Zealand University Hospital, Denmark. Complications were graded according to Clavien-Dindo classification of surgical complications. Multivariate logistic regression analysis was performed to estimate association between malignant disease and cardiovascular complications within 30 days of emergency laparotomy and to identify other risk factors for postoperative cardiovascular complications after emergency laparotomy. RESULTS We identified 1188 patients ≥18 years undergoing emergency laparotomy between 2010 and 2016, in which 254 (21%) had malignant disease. Within 30 days of emergency laparotomy, 89 (9.5%) of patients without malignancy died, as compared with 45 (18%) of patients with malignancy (p < 0.001). Cardiovascular death occurred in 17 (1.8%) and 5 (2.0%) patients in the non-malignant and malignant group, respectively. Severe cardiovascular complication graded CD 3-5 occurred in 93 (8%) of all patients within 30 days of emergency laparotomy. We found no association between malignancy and postoperative cardiovascular complications in patients undergoing emergency surgery (OR 0.8, 95% CI; 0.4, 1.5). Increasing age and ASA physical status classification system (ASA) score ≥ III were the only independent risk factors of cardiovascular complications graded CD 3-5. CONCLUSIONS Malignancy was not associated with postoperative cardiovascular complications after emergency laparotomy. Risk factors for major cardiovascular complications after emergency abdominal surgery were age and ASA score ≥ III.
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Affiliation(s)
- Rasmus Peuliche Vogelsang
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark. https://twitter.com/RasmusVogelsang
| | - Jacob Hartmann Søby
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark
| | - Mai-Britt Tolstrup
- Department of Abdominal, Bowel, and Liver Diseases, Herlev University Hospital, Denmark
| | - Jakob Burcharth
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark
| | - Sarah Ekeløf
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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Kler A, Dave M, Baltatzis M, Satyadas T. Elevation of High-sensitive Troponin T Predicts Mortality After Open Pancreaticoduodenectomy. World J Surg 2021; 45:1913-1920. [PMID: 33725140 DOI: 10.1007/s00268-021-06056-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Open pancreaticoduodenectomy has a high complication and measurable mortality rate. Recent reports (based across multiple surgical disciplines) demonstrate that elevated postoperative high sensitivity troponin T (hsTnT) predicts adverse outcomes in non-cardiac surgery. The aim of this study was to evaluate postoperative hsTnT as a prognostic marker of mortality, major adverse cardiovascular events (MACE), post-operative non-cardiac complications and length of stay (including intensive care stay) in open pancreaticoduodenectomy. METHODS A retrospective review of open pancreaticoduodenectomy patients was undertaken from 01/10/2017-31/03/2019. Receiver operating characteristic (ROC) curves were calculated to identify ideal cut-off values for hsTnT. Univariate and multivariate analyses were performed to scrutinize the relationship between mean hsTnT and 30-day, 90-day mortality, MACE, post-operative non-cardiac complications and length of stay. RESULTS One hundred and nine patients were identified. ROC curves demonstrated a strong correlation between elevated mean hsTnT and 30-day, 90-day mortality and MACE (AUC = 0.937, AUC = 0.852, AUC = 0.779, respectively). Multivariate analysis showed mean hsTnT > 21 ng/l was significantly associated with 90-day mortality (OR 43.928, p = 0.004) and MACE (OR 8.177, p = 0.048). CONCLUSIONS HsTnT is predictive of mortality and MACE in the context of open pancreaticoduodenectomy. Association between hsTnT and prolonged critical care stay was less significant. Non-cardiac complications and length of stay show no significant association with hsTnT.
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Affiliation(s)
- Aaron Kler
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK. .,, Manchester, UK.
| | - Madhav Dave
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Minas Baltatzis
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Thomas Satyadas
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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Sanders RD, Craigova L, Schessler B, Casey C, White M, Parker M, Kunkel D, Blennow K, Zetterberg H, Pearce RA, Lennertz R. Postoperative troponin increases after noncardiac surgery are associated with raised neurofilament light: a prospective observational cohort study. Br J Anaesth 2020; 126:791-798. [PMID: 33158499 DOI: 10.1016/j.bja.2020.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Myocardial and neuronal injury occur commonly after noncardiac surgery. We examined whether patients who had perioperative myocardial injury (PMI) also incurred neuronal injury, and whether myocardial and neuronal injury were associated with similar changes in inflammatory markers or overlapping clinical predictors. METHODS A total of 114 individuals >65 yr old were recruited from two ongoing perioperative cohort studies (NCT02926417; NCT03124303). Plasma samples were collected before and daily after surgery to process assays for troponin I (PMI), neurofilament light (NfL; neuronal injury) and multiplexed plasma cytokines (inflammation). The primary outcome was the change in NfL in individuals with PMI (>40 pg ml-1 increase in troponin above preoperative values). We conducted logistic regression to identify if there were shared clinical predictors for myocardial and neuronal injury. RESULTS Ninety-six patients had paired NfL and troponin data. Twenty-three of 94 subjects (24%) with PMI had greater increases in NfL (median [inter-quartile range, IQR]: 29 pg ml-1 [3-95 pg ml-1]; 2.8-fold increase) compared with subjects with no troponin increase (8 pg ml-1 [3-20]; 1.3-fold increase; P=0.008). PMI was associated with increased interleukin (IL)-1ra (P=0.005), IL-2 (P=0.045), IL-8 (P=0.002), and IL-10 (P<0.001). Logistic regression showed that intraoperative hypotension was associated with PMI (P=0.043). Preoperative stroke (P=0.041) and blood loss (P=0.002), but not intraoperative hypotension, were associated with increased NfL. CONCLUSIONS Postoperative troponin increases were associated with changes in NfL and inflammatory cytokines. Increases in troponin, but not NfL, were associated with intraoperative hypotension, suggesting differences in the mechanisms contributing to neuronal and myocardial injury.
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Affiliation(s)
- Robert D Sanders
- University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - Lenka Craigova
- Medical Student Training Program, University of Wisconsin, Madison, WI, USA
| | | | - Cameron Casey
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Marissa White
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Margaret Parker
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - David Kunkel
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Robert A Pearce
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Richard Lennertz
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
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Ekeloef S, Bjerrum E, Kristiansen P, Wahlstrøm K, Burcharth J, Gögenur I. The risk of post-operative myocardial injury after major emergency abdominal surgery: A retrospective cohort study. Acta Anaesthesiol Scand 2020; 64:1073-1081. [PMID: 32407553 DOI: 10.1111/aas.13622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim was to examine the risk of post-operative myocardial injury after major emergency abdominal surgery and identify pre- and intra-operative risk factors of post-operative myocardial injury. Moreover, the study aimed to examine the association between post-operative myocardial injury and clinical outcomes. METHODS This was a retrospective cohort study including patients undergoing major emergency abdominal surgery from February 2017 to January 2019. Troponin I was assessed on post-operative days 1-3. Post-operative myocardial injury was defined as a cardiac troponin I ≥ 45 ng per litre. Post-operative clinical outcomes included in-hospital myocardial infarction, in-hospital major adverse cardiovascular events, reoperation, admission to the intensive care unit, lengths of stay, 30- and 90-day all-cause mortality. RESULTS 98 out of 401 patients (24.4%) sustained a post-operative myocardial injury within the third post-operative day. Increasing age was an independent risk factor of post-operative myocardial injury (age per 10 years adjusted odds ratio 2.2 [95% CI 1.7-2.9], P < .0001). Patients with post-operative myocardial injury had an increased risk of major adverse cardiovascular events, a higher admission rate to the intensive care unit, a longer median post-operative length of stay and a higher 30- and 90-day all-cause mortality compared with patients without myocardial injury. CONCLUSION One in four patients suffered a post-operative myocardial injury within the third post-operative day. Post-operative myocardial injury was a risk factor of adverse cardiac and non-cardiac clinical outcomes. Troponin monitoring could potentially improve the post-operative risk stratification in this cohort of high-risk surgical patients.
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Affiliation(s)
- Sarah Ekeloef
- Department of Surgery Center for Surgical Science Zealand University Hospital Koege Denmark
| | - Ellen Bjerrum
- Department of Surgery Center for Surgical Science Zealand University Hospital Koege Denmark
| | - Puk Kristiansen
- Department of Surgery Center for Surgical Science Zealand University Hospital Koege Denmark
| | - Kirsten Wahlstrøm
- Department of Surgery Center for Surgical Science Zealand University Hospital Koege Denmark
| | - Jakob Burcharth
- Department of Surgery Center for Surgical Science Zealand University Hospital Koege Denmark
| | - Ismail Gögenur
- Department of Surgery Center for Surgical Science Zealand University Hospital Koege Denmark
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Systematic review and meta-analysis of postoperative troponin as a predictor of mortality and major adverse cardiac events after vascular surgery. J Vasc Surg 2020; 72:1132-1143.e1. [DOI: 10.1016/j.jvs.2020.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/06/2020] [Indexed: 01/11/2023]
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Immediate postoperative high-sensitivity troponin T concentrations and long-term patient-reported health-related quality of life: A prospective cohort study. Eur J Anaesthesiol 2020; 37:680-687. [PMID: 32618756 DOI: 10.1097/eja.0000000000001234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Myocardial injury after noncardiac surgery is associated with mortality and major adverse postoperative cardiovascular events. The effect of postoperative troponin concentrations on patient-reported health-related quality of life (HRQoL) is unknown. OBJECTIVE The study examined the association between immediate postoperative troponin concentrations and self-reported HRQoL 1 year after surgery. DESIGN Prospective cohort study. SETTING Single-centre tertiary care hospital in the Netherlands between July 2012 and 2015. PATIENTS Patients aged at least 60 years undergoing moderate and major noncardiac surgery. INTERVENTION None. MAIN OUTCOME MEASURES HRQoL total score was assessed with the EuroQol five-dimensional questionnaire. Tobit regression analysis was used to determine the association between postoperative troponin concentrations and 1-year HRQoL. Peak high-sensitivity troponin T values were divided into four categories: less than 14, 14 to 49, 50 to 149 and at least 150 ng l. RESULTS A total of 3085 patients with troponin measurements were included. 2634 (85.4%) patients were alive at 1-year follow-up of whom 1297 (49.2%) returned a completed questionnaire. The median score for HRQoL was 0.82 (0.85, 0.81, 0.77 and 0.71 per increasing troponin category). Multivariable analysis revealed betas of -0.06 [95% confidence interval (CI) -0.09 to -0.02], -0.11 (95% CI -0.18 to -0.04) and -0.18 (95% CI -0.29 to -0.07) for troponin levels of 14 to 49, 50 to 149 and at least 150 ng l when compared with values less than 14 ng l. Other independent predictors for lower HRQoL were chronic obstructive pulmonary disease, female sex, peripheral arterial disease and increasing age. CONCLUSION Higher levels of postoperative troponin measured immediately after surgery were independently associated with lower self-reported HRQoL total score at 1-year follow-up.
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Conti D, Ballo P, Ruggiano P, Boccalini R, Pavoni V, Sarti A. Very early postoperative troponin increase and clinical outcome in patients admitted to the recovery room after noncardiac surgery with suspected cardiac events. Indian Heart J 2020; 72:197-199. [PMID: 32768022 PMCID: PMC7411100 DOI: 10.1016/j.ihj.2020.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/12/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
We assessed the prognostic meaning of very early (<6 h) troponin increase after noncardiac surgery in a population of patients admitted to the recovery room, for whom troponin measurements were taken because of a suspected cardiac event. Among a total of 296 patients, abnormal troponin was found in 24 (8.1%). Ten patients in this group (41.7%) and 27 among those with normal troponin (9.9%) experienced cardiovascular death, myocardial infarction, or decompensated heart failure at one month (p < 0.0001). Troponin was independently associated with a two-fold risk of events (p < 0.0001). In these patients, very early troponin measurement in the recovery room may help to identify patients at risk of cardiovascular events.
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Affiliation(s)
- Duccio Conti
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy.
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Peggy Ruggiano
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Rossana Boccalini
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Vittorio Pavoni
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Armando Sarti
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Florence, Italy
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Complex relationship between low albumin level and poor outcome after lower extremity procedures for peripheral artery disease. J Vasc Surg 2020; 73:200-209. [PMID: 32470524 DOI: 10.1016/j.jvs.2020.04.524] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/30/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A low albumin level has been associated with poor outcome, including death, in surgical patients. The mechanistic relationship, however, is more complex than simply nutritional. As studies are scant in the vascular population, we sought to examine the association of low albumin level with outcomes in patients undergoing open and endovascular lower extremity procedures for peripheral artery disease. METHODS Patients with peripheral artery disease undergoing lower extremity procedures (2008-2015) were selected from Cerner Health Facts database (Cerner Corporation, Kansas City, Mo) using International Classification of Diseases, Ninth Revision diagnosis and procedure codes. Age, sex, disease severity, and other comorbidities were captured. Outcomes were identified using codes and encounter data. A χ2analysis and multivariable logistic regression were performed. RESULTS There were 6170 patients evaluated; 4562 (74%) underwent endovascular procedures and 1608 (26%) underwent open surgery. Low albumin level (<3.5 g/dL) was associated with age ≥80 years (23.1% vs 16.3% normal; P < .0001), black race (21% vs 11.6% normal; P < .0001), tissue loss (38% vs 16.4% normal; P < .0001), and higher Charlson index (mean, 3.1 vs 2.2 in the normal group; P < .0001). Low albumin level was also associated with longer length of stay (4.9 vs 2.2 days normal; P < .0001), higher in-hospital mortality (1.9% vs 0.3% normal; P < .0001), and higher 30-day readmission (15% vs 12.7% normal; P = .02). Multivariable analysis demonstrated that low albumin level was strongly associated with in-hospital death (odds ratio [OR], 5.23; 95% confidence interval [CI], 2.00-13.70), infection (OR, 2.51; 95% CI, 1.96-3.22), renal failure (OR, 2.61; 95% CI, 1.79-3.79), and cardiac complications (OR, 2.59; 95% CI, 1.69-3.96). After multivariable adjustment, there was no association between albumin level and 30-day readmission. CONCLUSIONS Low preoperative albumin levels are associated with in-hospital death, prolonged length of stay, and severe morbidity after open and endovascular lower extremity procedures. As the majority of lower extremity procedures are elective, serious consideration should be given to deferring elective procedures until albumin levels have been optimized. Because of the pleiotropic effects of albumin, including antiplatelet and inflammatory function, study of this complex relationship may offer insights into how best to integrate this novel biomarker into vascular surgery decision-making.
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Uchoa RB, Caramelli B. Troponin I as a mortality marker after lung resection surgery - a prospective cohort study. BMC Anesthesiol 2020; 20:118. [PMID: 32429842 PMCID: PMC7236915 DOI: 10.1186/s12871-020-01037-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular complications associated with thoracic surgery increase morbidity, mortality, and treatment costs. Elevated cardiac troponin level represents a predictor of complications after non-cardiac surgeries, but its role after thoracic surgeries remains undetermined. The objective of this study was to analyze the relationship between troponin I elevation and morbidity and mortality after one year in patients undergoing lung resection surgery. METHODS This prospective cohort study evaluated 151 consecutive patients subjected to elective lung resection procedures using conventional and video-assisted thoracoscopic techniques at a University Hospital in Brazil, from July 2012 to November 2015. Preoperative risk stratification was performed using the scores obtained by the American College of Physicians (ACP) and the Society of Cardiology of the state of São Paulo (EMAPO) scoring systems. Troponin I levels were measured in the immediate postoperative period (POi) and on the first and second postoperative days. RESULTS Most patients had a low risk for complications according to the ACP (96.7%) and EMAPO (82.8%) scores. Approximately 49% of the patients exhibited increased troponin I (≥0.16 ng/ml), at least once, and 22 (14.6%) died in one year. Multivariate analysis showed that the elevation of troponin I, on the first postoperative day, correlated with a 12-fold increase in mortality risk within one year (HR 12.02, 95% CI: 1.82-79.5; p = 0.01). CONCLUSIONS In patients undergoing lung resection surgery, with a low risk of complications according to the preoperative evaluation scores, an increase in troponin I levels above 0.16 ng/ml in the first postoperative period correlated with an increase in mortality within one year.
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Affiliation(s)
- Ricardo B Uchoa
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Maestro Elias Lobo 596, São Paulo, SP, CEP 01433-000, Brazil
| | - Bruno Caramelli
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Maestro Elias Lobo 596, São Paulo, SP, CEP 01433-000, Brazil.
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Takahashi R, Fujikawa T. Impact of perioperative aspirin continuation on bleeding complications in laparoscopic colorectal cancer surgery: a propensity score-matched analysis. Surg Endosc 2020; 35:2075-2083. [PMID: 32372221 DOI: 10.1007/s00464-020-07604-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND In laparoscopic surgery for colorectal cancer (CRC) for patients who receive antiplatelet therapy (APT), it remains unclear whether APT should be continued or temporarily withdrawn. We investigated the safety of perioperative aspirin continuation, specifically focused on bleeding complications. METHODS We performed retrospective analysis utilizing propensity score-matching (PSM). In total, 789 patients satisfied the inclusion criteria, and were divided into two groups. Patients in the continued aspirin monotherapy (cAPT) group continued treatment perioperatively with not more than 2 days of withdrawal (n = 140). Patients with more than 3 days withdrawal of aspirin or who did not receive APT at all were assigned to the non-cAPT group (n = 649). After 1:1 PSM, 105 patients were extracted from each group. Perioperative APT management was determined based on our institutional committee-approved guidelines for antithrombotic management. RESULTS In PSM cohorts, all patient demographics were comparable between the groups. Regarding intraoperative outcomes, we found no significant difference in operation duration (p = 0.969), blood loss (p = 0.068), and blood transfusion (p = 0.517). Postoperative overall morbidity was 20.0% and 13.3% in the cAPT and non-cAPT groups, respectively (p = 0.195). The incidence of bleeding complications was also comparable between the groups (2.9% vs. 1.0%, p = 0.317). Assessing the 14 cases with bleeding complications overall in the full cohort, all 7 cases in the non-cAPT group had anastomotic bleeding, which was generally observed shortly after surgery [median postoperative day (POD) 1]. All 7 cases in the cAPT group received additional antithrombotics other than aspirin; bleeding occurred at various sites relatively later (median POD 7), mostly after reinstitution of additional antithrombotic agents. CONCLUSIONS For patients receiving APT, perioperative continuation of aspirin monotherapy could be safe in laparoscopic CRC surgery; however, careful consideration is required at reinstitution of additional antithrombotics where multiple antithrombotic agents are used.
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Affiliation(s)
- Ryo Takahashi
- Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka, 8028555, Japan
| | - Takahisa Fujikawa
- Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka, 8028555, Japan.
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Hosseinifard H, Ghadimi N, Kaveh S, Shabaninejad H, Lijassi A, Azarfarin R. Comparing cardiac troponin levels using sevoflurane and isoflurane in patients undergoing cardiac surgery: a systematic review and meta-analysis. J Cardiovasc Thorac Res 2020; 12:1-9. [PMID: 32211131 PMCID: PMC7080340 DOI: 10.34172/jcvtr.2020.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 01/10/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction: Cardiac troponin is one of the heart biomarkers and its high levels correlates with a high risk of cardiomyocytes damage. This study aimed to compare sevoflurane and isoflurane effect on troponin levels in patients undergoing cardiac surgery. Methods: We systematically searched for RCTs which had been published in Cochrane library, PubMed, Web of science, CRD, Scopus, and Google Scholar by the end of February 30th, 2019. The quality of articles was evaluated with the Cochrane checklist. GRADE was used for quality of evidence for this meta-analysis. Meta-analysis was done based on random or fixed effect model. Results: Five studies with total of 190 (sevoflurane) and 191 (isoflurane) patients were included. The results showed that pooled mean difference of troponin levels between the two groups was significant at ICU admission time and 24 hours after entering. The comparison of troponin level changes between the two groups (baseline = at time ICU) in 24 and 48 hours after ICU admission was significant. Conclusion: This meta-analysis showed that blood troponin levels were significantly lower at the time of arrival in ICU with isoflurane and after 24 hours with sevoflurane. Generally, given the small mean difference between isoflurane and sevoflurane, it seems that none of the medications has a negative effect on the cardiac troponin level.
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Affiliation(s)
- Hossein Hosseinifard
- Biostatistics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Nashmil Ghadimi
- Health Technology Assessment, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Kaveh
- Health Technology Assessment, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Shabaninejad
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.,Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Alaadine Lijassi
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco
| | - Rasoul Azarfarin
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Tabata N, Weber M, Sugiura A, Ishii M, Öztürk C, Tsujita K, Sinning JM, Werner N, Nickenig G. Impact of combined baseline and postprocedural troponin values on clinical outcome following the MitraClip procedure. Catheter Cardiovasc Interv 2020; 96:E735-E743. [PMID: 32212302 DOI: 10.1002/ccd.28869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/27/2020] [Accepted: 03/17/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the impact of periprocedural troponin levels on clinical outcome following the MitraClip procedure. BACKGROUND Cardiac troponin is known to be a predictive biomarker for various clinical outcomes; however, data about its predictive value in patients undergoing transcatheter mitral valve repair are limited. METHODS Consecutive patients undergoing the MitraClip procedure were enrolled. Serum cardiac troponin I concentrations were measured before and after the procedure, and the maximal value recorded within 72 hr after the procedure was used for the postprocedural values. The clinical outcome was all-cause mortality within a 1-year follow-up. RESULTS Out of 354 patients, 29 patients (8.2%) were deceased within 1 year. Patients who died had significantly higher baseline (0.05 [0.01-0.08] vs. 0.01 [0.01-0.03] ng/ml; p < .001) and postprocedural troponin I values (0.51 [0.30-1.42] vs. 0.20 [0.33-0.55] ng/ml; p = .005). A Kaplan-Meier analysis showed that patients with higher baseline troponin I values had a significantly worse prognosis than those with lower values (log-rank p < .001), and similarly, 1-year mortality was significantly higher in patients with higher postprocedural troponin I than those with lower levels (log-rank p = .021). Moreover, the highest mortality rate was observed in patients with both elevated baseline and postprocedural troponin I values (log-rank p = .001), which was found to be an independent predictor of mortality by multivariable analyses. CONCLUSIONS The present study suggests that combined baseline and postprocedural troponin measurements are useful for risk stratification of 1-year mortality following the MitraClip procedure.
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Affiliation(s)
- Noriaki Tabata
- Heart Center Bonn, Department of Medicine II, University Hospital, Bonn, Germany.,Department of Cardiovascular Medicine Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital, Bonn, Germany
| | - Masanobu Ishii
- Department of Cardiovascular Medicine Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital, Bonn, Germany
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Jan-Malte Sinning
- Heart Center Bonn, Department of Medicine II, University Hospital, Bonn, Germany
| | - Nikos Werner
- Heart Center Bonn, Department of Medicine II, University Hospital, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital, Bonn, Germany
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Sun K, Wang Y, Yan M, Xia VW. Pretransplant left ventricular hypertrophy in association with postoperative myocardial injury in liver transplantation. Clin Transplant 2020; 34:e13847. [PMID: 32097498 DOI: 10.1111/ctr.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/17/2020] [Accepted: 02/22/2020] [Indexed: 12/01/2022]
Abstract
Pretransplant left ventricular hypertrophy (LVH) is a common finding during preoperative cardiac evaluation. We hypothesized that patients with pretransplant LVH were associated with a higher risk of postoperative myocardial injury (PMI) in adult patients undergoing liver transplantation (LT). A retrospective cohort analysis was performed by reviewing the medical records of adult patients who underwent LT between January 2006 and October 2013. Of 893 patients, the incidences of mild, moderate, and severe LVH were 7.8%, 5.6%, and 2.5%, respectively. Propensity match was used to eliminate the pretransplant imbalance between the LVH and non-LVH groups. In after-match patients, 23.5% of LVH patients developed PMI compared to 11.8% in the control group (P = .011). The incidence of PMI in patients with moderate-severe degrees of LVH was significantly higher compared with that in patients with mild LVH (27.9% vs 19.1%, P = .016). When controlling intraoperative variables, patients with LVH had 4.5 higher odds of developing PMI (95% CI1.18-17.19, P = .028). Patients experiencing PMI had significantly higher 1-year mortality (37.5% vs 15.7%, log-rank test P < .001). Our results suggest that patients with pretransplant LVH were at a high risk of developing PMI and should be monitored closely in the perioperative period. More studies are warranted.
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Affiliation(s)
- Kai Sun
- Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Wang
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Min Yan
- Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Victor W Xia
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ackland GL, Abbott TEF, Jones TF, Leuwer M, Pearse RM. Early elevation in plasma high-sensitivity troponin T and morbidity after elective noncardiac surgery: prospective multicentre observational cohort study. Br J Anaesth 2020; 124:535-543. [PMID: 32147104 DOI: 10.1016/j.bja.2020.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Elevated high-sensitivity troponin (hsTnT) after noncardiac surgery is associated with higher mortality, but the temporal relationship between early elevated troponin and the later development of noncardiac morbidity remains unclear. METHODS Prospective observational study of patients aged ≥45 yr undergoing major noncardiac surgery at four UK hospitals (two masked to hsTnT). The exposure of interest was early elevated troponin, as defined by hsTnT >99th centile (≥15 ng L-1) within 24 h after surgery. The primary outcome was morbidity 72 h after surgery, defined by the Postoperative Morbidity Survey (POMS). Secondary outcomes were time to become morbidity-free and Clavien-Dindo ≥grade 3 complications. RESULTS Early elevated troponin (median 21 ng L-1 [16-32]) occurred in 992 of 4335 (22.9%) patients undergoing elective noncardiac surgery (mean [standard deviation, sd] age, 65 [11] yr; 2385 [54.9%] male). Noncardiac morbidity was more frequent in 494/992 (49.8%) patients with early elevated troponin compared with 1127/3343 (33.7%) patients with hsTnT <99th centile (odds ratio [OR]=1.95; 95% confidence interval [CI], 1.69-2.25). Patients with early elevated troponin had a higher risk of proven/suspected infectious morbidity (OR=1.54; 95% CI, 1.24-1.91) and critical care utilisation (OR=2.05; 95% CI, 1.73-2.43). Clavien-Dindo ≥grade 3 complications occurred in 167/992 (16.8%) patients with early elevated troponin, compared with 319/3343 (9.5%) patients with hsTnT <99th centile (OR=1.78; 95% CI, 1.48-2.14). Absence of early elevated troponin was associated with morbidity-free recovery (OR=0.44; 95% CI, 0.39-0.51). CONCLUSIONS Early elevated troponin within 24 h of elective noncardiac surgery precedes the subsequent development of noncardiac organ dysfunction and may help stratify levels of postoperative care in real time.
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Affiliation(s)
- Gareth L Ackland
- William Harvey Research Institute, Queen Mary University of London, London, UK.
| | - Tom E F Abbott
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Timothy F Jones
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Martin Leuwer
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Rupert M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
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De Hert SG, Lurati Buse GA. Cardiac Biomarkers for the Prediction and Detection of Adverse Cardiac Events After Noncardiac Surgery: A Narrative Review. Anesth Analg 2020; 131:187-195. [DOI: 10.1213/ane.0000000000004711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Lowe MJ, Lightfoot NJ. The prognostic implication of perioperative cardiac enzyme elevation in patients with fractured neck of femur: A systematic review and meta-analysis. Injury 2020; 51:164-173. [PMID: 31879176 DOI: 10.1016/j.injury.2019.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/11/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Neck of Femur (NOF) fractures are a common injury in comorbid elderly patients which are associated with increased rates of morbidity and mortality following fracture. Because of their injury, patients can experience reductions in quality of life and independent living leading to transfer to nursing home or dependent levels of care. Numerous factors are associated with either complications or reductions in survival following fractured NOF. From the VISION cohort there is evidence that troponin elevation in the post-operative period following a diverse range of non-cardiac surgical procedures may lead to an increased risk of mortality in the absence of classical ischaemic or cardiac symptoms. The aim of this systematic review and meta-analysis is to validate the utility of perioperative troponin elevation as a prognostic indicator for mortality and cardiac morbidity in those with fractured NOF. METHODS The PRISMA guidelines for the conduct of meta-analyses were followed. An electronic search was conducted of the EMBASE, MEDLINE (Ovid) and Biosis databases. Studies were included for analysis if they stratified outcomes by perioperative troponin elevation in surgically managed fractured NOF and reported sufficient data on troponin elevation and mortality following surgery. Primary and secondary outcomes assessed were all-cause post-operative mortality and a composite measure of cardiac complications (myocardial infarction, cardiac failure and arrhythmia) respectively. RESULTS Eleven studies met inclusion criteria giving a total of 1363 patients. Overall, 497 patients (36.5%) experienced an elevation in troponin levels following surgery. Perioperative troponin elevation was significantly associated with all-cause mortality (OR 2.6; 95% CI 1.5 - 4.6; p <0.001) and cardiac complications (OR 7.4; 95% CI 3.5 - 15.8; p <0.001). Patient factors significantly associated with troponin elevation included pre-existing coronary artery disease, cardiac failure, hypertension, previous stroke and previous myocardial infarction. CONCLUSION Perioperative troponin elevation is significantly associated with increased mortality and post-operative cardiac complications following fractured NOF and may be a useful prognostic indicator in these patients. Future research should further stratify patients by the magnitude of troponin elevation and further refine the risk factors.
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Affiliation(s)
- Matthew J Lowe
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
| | - Nicholas J Lightfoot
- Department of Anaesthesia and Pain Medicine, Middlemore Hospital, Auckland, New Zealand
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Lee SH, Kim JA, Heo B, Kim YR, Ahn HJ, Yang M, Jang J, Ahn S. Association between intraoperative hypotension and postoperative myocardial injury in patients with prior coronary stents undergoing high-risk surgery: a retrospective study. J Anesth 2020; 34:257-267. [PMID: 31965251 DOI: 10.1007/s00540-020-02736-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/13/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE We conducted a single-center retrospective study to evaluate the effects of intraoperative hypotension (IOH) on postoperative myocardial injury during major noncardiac surgery in patients with prior coronary stents with preoperatively normal cardiac troponin I levels. Although IOH is assumed to increase the risk of postoperative myocardial injury in patients with prior coronary stents, the level and duration of hazardous low blood pressure have not been clarified. METHODS Of 2517 patients with prior coronary stents undergoing noncardiac surgery between January 2010 and March 2017, we analyzed 195 undergoing major surgery (vascular, abdominal, and thoracic surgery) who had a normal preoperative high-sensitivity cardiac troponin I (hs-cTnI) level and were followed up postoperatively within 3 days. Postoperative myocardial injury was defined as a hs-cTnI level greater than the 99th percentile reference value. Primary IOH exposure was defined as a decrease of ≥ 50%, 40%, or 30% from the preinduction mean blood pressure. Additional definition of IOH was absolute mean blood pressure < 70, < 60 or < 50 mmHg. Multivariate logistic regression was used to model the exposure and myocardial injury. RESULTS Myocardial injury occurred in 53 (27.2%) cases. The predefined levels of IOH were not significantly associated with postoperative myocardial injury, but intraoperative continuous inotropes/vasopressors use was significantly higher in patients with myocardial injury (P = 0.004). Operation time ≥ 166 min (OR = 2.823, 95% CI 1.184-6.731, P = 0.019) and abdominal vascular surgery (OR = 2.693, 95% CI 1.213-5.976, P = 0.015) were independent risk factors for myocardial injury. CONCLUSION Although patients with prior coronary stents with normal hs-cTnI levels did not show association between varying levels of IOH and postoperative myocardial injury after noncardiac surgery, intraoperative need of continuous inotropes/vasopressors was higher in patients with postoperative myocardial injury. Abdominal vascular surgery and surgical time were independent risk factors for myocardial injury after surgery.
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Affiliation(s)
- Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jie Ae Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-Gu, Seoul, 06351, South Korea.
| | - BurnYoung Heo
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Young Ri Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Mikyung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jaeni Jang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Soohyun Ahn
- Department of Mathematics, Ajou University, Suwon, South Korea
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Zhao BC, Liu WF, Deng QW, Zhuang PP, Liu J, Li C, Liu KX. Meta-analysis of preoperative high-sensitivity cardiac troponin measurement in non-cardiac surgical patients at risk of cardiovascular complications. Br J Surg 2020; 107:e81-e90. [PMID: 31903596 DOI: 10.1002/bjs.11305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/03/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022]
Abstract
Abstract
Background
Patients undergoing major non-cardiac surgery are at risk of cardiovascular complications. Raised levels of high-sensitivity troponin are frequently detected before operation among these patients. However, the prognostic value of high-sensitivity troponin in predicting postoperative outcomes remains unclear.
Methods
A systematic search of PubMed, Embase and Science Citation Index Expanded was undertaken for observational studies published before March 2018 that reported associations between raised preoperative levels of high-sensitivity troponin and postoperative major adverse cardiac events and/or mortality after non-cardiac surgery. Meta-analyses were performed, where possible, using random-effects models.
Results
Seven cohort studies with a total of 4836 patients were included. A raised preoperative high-sensitivity troponin level was associated with a higher risk of short-term major adverse cardiac events (risk ratio (RR) 2·92, 95 per cent c.i. 1·96 to 4·37; I2 = 82·6 per cent), short-term mortality (RR 5·39, 3·21 to 9·06; I2 = 0 per cent) and long-term mortality (RR 2·90, 1·83 to 4·59, I2 = 74·2 per cent). The addition of preoperative high-sensitivity troponin measurement provided improvements in cardiovascular risk discrimination (increase in C-index ranged from 0·058 to 0·109) and classification (quantified by continuous net reclassification improvement) compared with Lee's Revised Cardiac Risk Index alone. There was substantial heterogeneity and inadequate risk stratification analysis in the included studies.
Conclusion
Raised preoperative levels of high-sensitivity troponin appear to represent a risk for postoperative major adverse cardiac events and mortality. Further study is required before high-sensitivity troponin can be used to predict risk stratification in routine clinical practice.
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Affiliation(s)
- B-C Zhao
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - W-F Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Q-W Deng
- Department of Anaesthesiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - P-P Zhuang
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - J Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - C Li
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - K-X Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Wu CC, Hsu WD, Wang YC, Kung WM, Tzeng IS, Huang CW, Huang CY, Li YC. An Innovative Scoring System for Predicting Major Adverse Cardiac Events in Patients With Chest Pain Based on Machine Learning. IEEE ACCESS 2020. [DOI: 10.1109/access.2020.3004405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Bojesen RD, Fitzgerald P, Munk-Madsen P, Eriksen JR, Kehlet H, Gögenur I. The clinical implication of the association between hypoxaemia and postoperative troponin I: a reply. Anaesthesia 2019; 75:128-129. [PMID: 31794643 DOI: 10.1111/anae.14917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - H Kehlet
- Zealand University Hospital, Køge, Denmark
| | - I Gögenur
- Zealand University Hospital, Køge, Denmark
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