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Golubovic M, Peric V, Stanojevic D, Lazarevic M, Jovanovic N, Ilic N, Djordjevic M, Kostic T, Milic D. Potential New Approaches in Predicting Adverse Cardiac Events One Month after Major Vascular Surgery. Med Princ Pract 2019; 28:63-69. [PMID: 30391950 PMCID: PMC6558343 DOI: 10.1159/000495079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/04/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The aim of our study was to find the best model with sufficient power to improve the risk stratification in major vascular surgery patients during the first 30 days after this procedure. The discriminatory power of 4 biomarkers (troponin I [TnI], N-terminal prohormone of brain natriuretic peptide [NT-proBNP], creatine kinase-MB isoenzyme [CK-MB], high-sensitivity C-reactive protein [hs-CRP]) was tested as well as 2 risk assessment models and 13 different combinations of them. SUBJECTS AND METHODS The study included 122 patients (77% men, 23% women) with an average age of 67.03 ± 4.5 years. An aortobifemoral bypass was performed in 6.56% of the patients, a femoropopliteal bypass in 18.85%, and 49.18% received open surgical reconstruction of the carotid arteries. A total of 25.41% of the patients were given an aortobi-iliac bypass. RESULTS During the first 30 days, 13 patients (10.7%) had 17 cardiac complications. The most common complication was the new onset of atrial fibrillation (35.3%). During the first 10 days, 10 patients had 1 complication and 2 patients had 2 cardiac events, while 1 patient had 3 complications. By comparing combinations of scores and markers, it was shown that revised cardiac risk index (RCRI) + Vascular Portsmouth Physiological and Operative Severity Score (V-POSSUM) + hsTnI and RCRI + V-POSSUM + hsTnI + NT-proBNP with 100% sensitivity, > 80% specificity had the best discriminatory ability (AUC 0.924 and 0.933, respectively; p < 0.001 for both models) for cardiac complications during the 30 days after surgery. CONCLUSION Combinations of traditional preoperative risk factors and scores can enhance the assessment of major adverse cardiac events (MACE) in patients preparing for large vascular surgery. Using only one risk score in these patients seems to be underperforming in preoperative risk assessment.
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Affiliation(s)
- Mladjan Golubovic
- Clinic for Anesthesiology and Reanimatology, Clinical Center Nis, Nis, Serbia,
| | | | | | - Milan Lazarevic
- Clinic for Cardiovascular and Transplantation Surgery, Clinical Center Nis, Nis, Serbia
| | - Nenad Jovanovic
- Clinic for Anesthesiology and Reanimatology, Clinical Center Nis, Nis, Serbia
| | - Nenad Ilic
- Clinic for Cardiovascular and Transplantation Surgery, Clinical Center Nis, Nis, Serbia
| | | | - Tomslav Kostic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Clinic for Cardiology, Clinical Center Nis, Nis, Serbia
| | - Dragan Milic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Clinic for Cardiovascular and Transplantation Surgery, Clinical Center Nis, Nis, Serbia
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Ye Z, Lu H, Su Q, Long M, Li L. Efficacy and safety of nicorandil on perioperative myocardial injury in patients undergoing elective percutaneous coronary intervention: results of the PENMIPCI trial. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2591-2599. [PMID: 30174413 PMCID: PMC6110631 DOI: 10.2147/dddt.s173931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Previous studies have indicated that nicorandil can reduce perioperative myocardial injury (PMI) in patients undergoing elective percutaneous coronary intervention (ePCI), but this conclusion is still controversial. Additionally, studies reporting on the safety of nicorandil are lacking. Therefore, we performed this prospective study to evaluate the efficacy and safety of nicorandil on PMI in patients undergoing ePCI. Methods One hundred and forty-six patients with coronary heart disease (CHD) scheduled to undergo ePCI were randomly assigned to the nicorandil group (n=74) or control group (n=72). The primary outcomes were the change in cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) at 12 and 24 hours after surgery. The secondary outcome was the incidence of major adverse cardiac events (MACE), which was a composite of cardiac death, nonfatal myocardial infarction, new heart failure or coronary revascularization. Results There was no difference in age (54.76±5.93 vs 56.35±5.22) between the nicorandil group and the control group. In addition, no differences were observed in the cTnT and CK-MB levels between the two groups at admission (all P⩾0.05). Compared with those in the control group, the cTnT (0.15±0.12 vs 0.12±0.10 at 12 hours and 0.17±0.12 vs 0.13±0.10 at 24 hours) and CK-MB (15.35±8.23 vs 12.31±7.93 at 12 hours and 13.63±8.87 vs 11.13±5.71 at 24 hours) levels in the nicorandil group were significantly decreased after surgery (all P⩽0.05). Furthermore, nicorandil did not increase the incidence of MACE in the nicorandil group compared with the control group (12.16% vs 12.50%). Conclusions Nicorandil can reduce PMI in patients undergoing ePCI and does not increase the incidence of MACE. Clinical Trial Registration URL: http://www.chictr.org.cn/. Unique Identifier: ChiCTR-IOR-17012056.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China, ; 3224014648@.com
| | - Haili Lu
- Department of Orthodontics, The Affiliated Dental Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Qiang Su
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China, ; 3224014648@.com
| | - Manyun Long
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China, ; 3224014648@.com
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China, ; 3224014648@.com
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Kim IJ, Moon JY, Ko EJ, Lim YM, Kim SH, Yang WI, Sung JH, Lim SW, Cha DH. Prognostic value of preoperative N-terminal pro-brain natriuretic peptide in non-cardiac surgery of elderly patients with normal left ventricular systolic function. Geriatr Gerontol Int 2015; 16:1109-1116. [PMID: 26336935 DOI: 10.1111/ggi.12597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/29/2022]
Abstract
AIM We investigated the prognostic value of preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) in non-cardiac surgery in elderly patients who showed normal left ventricular function on preoperative echocardiography. METHODS We analyzed 1459 patients aged older than 70 years who had consulted a cardiologist for the evaluation of cardiovascular risk for non-cardiac surgery. Of the 721 patients who simultaneously underwent echocardiography and NT-proBNP assessments, 506 who showed normal left ventricular systolic function were included. The predictive power of NT-proBNP for the risk of major adverse cardiac and cerebrovascular events (MACCE) was evaluated. RESULTS MACCE occurred in 40 (7.9%) of the 506 patients, and the median value of NT-proBNP was higher in patients with complications than in those without (MACCE group: 1700.5 pg/mL vs non MACCE group: 206.35 pg/mL; P < 0.001). The area under the receiver operating characteristic curve was 0.804 (P < 0.001), with an optimal cut-off of 425.3 pg/mL. Multivariate analysis showed that increased NT-proBNP (>425.3 pg/mL; odds ratio 6.381; P < 0.001) was the only independent risk factor for the prediction of MACCE. CONCLUSIONS In elderly patients who showed normal left ventricular systolic function on echocardiography, measurement of preoperative NT-proBNP concentration might be a useful test for predicting the occurrence of MACCE after non-cardiac surgery. Geriatr Gerontol Int 2016; 16: 1109-1116.
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Affiliation(s)
- In Jai Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jae Youn Moon
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
| | - Eun-Jung Ko
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yeong-Min Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Hoon Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Woo-In Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang-Wook Lim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dong-Hun Cha
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Ryan L, Rajah C, Simmers D, Potgieter D, Rodseth RN. Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative meta-analysis. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2015.1075938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bae MH, Lee JH, Yang DH, Park HS, Cho Y, Chae SC. Usefulness of Surgical Parameters as Predictors of Postoperative Cardiac Events in Patients Undergoing Non-Cardiac Surgery. Circ J 2014; 78:718-23. [DOI: 10.1253/circj.cj-13-1208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University School of Medicine
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University School of Medicine
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University School of Medicine
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University School of Medicine
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University School of Medicine
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Bae MH, Jang SY, Choi WS, Kim KH, Park SH, Lee JH, Kim HK, Yang DH, Huh S, Park HS, Cho Y, Chae SC. A new revised cardiac risk index incorporating fragmented QRS complex as a prognostic marker in patients undergoing noncardiac vascular surgery. Am J Cardiol 2013; 112:122-7. [PMID: 23768543 DOI: 10.1016/j.amjcard.2013.02.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/28/2013] [Accepted: 02/28/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate the value of a new Revised Cardiac Risk Index (RCRI) that includes consideration of QRS fragmentation (fQRS) as a predictor of cardiac events in patients undergoing noncardiac vascular surgery. Four hundred sixty-seven consecutive patients admitted for noncardiac vascular surgery were studied. Patients were allocated to RCRI 0, 1, 2, or ≥3 groups according to the sum of diabetes, renal insufficiency, and histories of ischemic heart disease, congestive heart failure, and cerebrovascular disease. They were then reallocated to fragmented RCRI (fRCRI) 0, 1, 2, or ≥3 groups after including a score of 1 or 0 corresponding to the presence or absence of fQRS. A major adverse cardiac event (MACE) was defined as a composite of death, myocardial infarction, congestive heart failure, and percutaneous coronary intervention before noncardiac vascular surgery. During index hospitalization, MACE developed in 38 patients (8.1%). fQRS was present in 169 (36.2%), and it was significantly greater in patients with MACE than in those without MACE (63.2% vs 34.3%, p <0.001). The proportions of RCRI 0, 1, 2, and ≥3 were 46.9% (n = 219), 35.3% (n = 165), 12.4% (n = 58), and 5.4% (n = 25), respectively. When fRCRI data were included, 28 patients (48.3%) in RCRI 2 were reclassified as fRCRI ≥3. By multivariate logistic regression analysis, fRCRI (odds ratio 1.529, 95% confidence interval 1.035 to 2.258, p = 0.033) and a left ventricular ejection fraction <50% independently predicted in-hospital MACE. In conclusion, fRCRI is an independent predictor of in-hospital MACE in patients undergoing noncardiac vascular surgery.
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Preoperative HO-1 levels as prognostic factor for adverse cardiac events in elder patients undergoing non-cardiac surgery. PLoS One 2013; 8:e58567. [PMID: 23526997 PMCID: PMC3602373 DOI: 10.1371/journal.pone.0058567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/05/2013] [Indexed: 11/19/2022] Open
Abstract
Background Hypoxia-inducible factor-1α (HIF-1α) and heme oxygenase-1(HO-1) are involved in the tissue hypoxic response. Hypothesis HIF-1α and HO-1 levels may predict cardiac ischemia and adverse cardiac events during non-cardiac surgery. Methods HIF-1α and HO-1 levels were determined in elderly patients undergoing non-cardiac surgery preoperatively and at 30 minutes, 48 and 72 hours postoperatively. Results were analyzed with respect to the occurrence of adverse cardiac events. Results A total of 380 patients with a mean age of 65.3 years were included, and 54 (14.2%) who had adverse cardiac events during or after the surgery. HIF-1α and HO-1 levels in the adverse cardiac event group were significantly higher than in the group without adverse cardiac events at each time point (all, P<0.05). In multivariates regression analysis, the odds of an adverse cardiac event was increased by every 1-year increase in age (odd ratio [OR] 1.39, P<0.001), abnormal ECG at baseline (OR 2.27, P = 0.048), myocardial infarction history (OR 3.18, P = 0.015), and positive baseline cTnI level were associated with an increased likelihood of an adverse cardiac event (OR 8.78, P = 0.019), and for every 1 unit increase of HO-1, the odds of an adverse cardiac event increased by 1.30 (P = 0.002). Conclusion Determination of preoperative HO-1 levels may aid in identifying patients at risk of developing ischemic cardiac events.
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Yang JH, Choi JH, Ki YW, Kim DI, Kim DK, Park JR, Oh JK, Choi SH. Plasma N-terminal pro-B-type natriuretic peptide is predictive of perioperative cardiac events in patients undergoing vascular surgery. Korean J Intern Med 2012; 27:301-10. [PMID: 23019395 PMCID: PMC3443723 DOI: 10.3904/kjim.2012.27.3.301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/13/2012] [Accepted: 05/17/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Identification of patients at high risk for perioperative cardiac events (POCE) is clinically important. This study aimed to determine whether preoperative measurement of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) could predict POCE, and compared its predictive value with that of conventional cardiac risk factors and stress thallium scans in patients undergoing vascular surgery. METHODS Patients scheduled for non-cardiac vascular surgery were prospectively enrolled. Clinical risk factors were identified, and NT-proBNP levels and stress thallium scans were obtained. POCE was the composite of acute myocardial infarction, congestive heart failure including acute pulmonary edema, and primary cardiac death within 5 days after surgery. A modified Revised Cardiac Risk Index (RCRI) was proposed and compared with NT-proBNP; a positive result for ischemia and a significant perfusion defect (≥ 3 walls, moderate to severely decreased, reversible perfusion defect) on the thallium scan were added to the RCRI. RESULTS A total of 365 patients (91% males) with a mean age of 67 years had a median NT-proBNP level of 105.1 pg/mL (range of quartile, 50.9 to 301.9). POCE occurred in 49 (13.4%) patients. After adjustment for confounders, an NT-proBNP level of > 302 pg/mL (odds ratio [OR], 5.7; 95% confidence interval [CI], 3.1 to 10.3; p < 0.001) and a high risk by the modified RCRI (OR, 3.9; 95% CI, 1.6 to 9.3; p = 0.002) were independent predictors for POCE. Comparison of the area under the curves for predicting POCE showed no statistical differences between NT-proBNP and RCRI. CONCLUSIONS Preoperative measurement of NT-proBNP provides information useful for prediction of POCE as a single parameter in high-risk patients undergoing noncardiac vascular surgery.
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Affiliation(s)
- Ji Hyun Yang
- Division of Cardiology, Department of Internal Medicine, The Armed Forces Capital Hospital, Seongnam, Korea
| | - Jin Ho Choi
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Ki
- Department of Vascular Surgery, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ik Kim
- Department of Vascular Surgery, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Kyung Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae K. Oh
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Bae MH, Choi WS, Kim KH, Park SH, Kim HW, Lee JH, Lee SW, Yang DH, Park HS, Cho Y, Chae SC, Jun JE. The implications of a fragmented QRS complex and newly reclassified revised cardiac risk index including fragmented QRS in patients undergoing non-cardiac vascular surgery. Int J Cardiol 2012; 157:276-8. [DOI: 10.1016/j.ijcard.2012.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 03/03/2012] [Indexed: 11/16/2022]
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Jeon DS. Role of brain natriuretic Peptide as a prognostic marker in non-cardiac surgery. Korean Circ J 2011; 41:9-10. [PMID: 21359062 PMCID: PMC3040406 DOI: 10.4070/kcj.2011.41.1.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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