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Myocardial injury noncardiac surgery

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https://www.readbyqxmd.com/read/28719430/high-sensitivity-cardiac-troponin-t-improves-the-diagnosis-of-perioperative-mi
#1
Jamie C Brown, Eslam Samaha, Srikar Rao, Mohammad A Helwani, Andreas Duma, Frank Brown, Brian F Gage, J Philip Miller, Allan S Jaffe, Fred S Apple, Mitchell G Scott, Peter Nagele
BACKGROUND: The diagnosis of myocardial infarction (MI) after noncardiac surgery has traditionally relied on using relatively insensitive contemporary cardiac troponin (cTn) assays. We hypothesized that using a recently introduced novel high-sensitivity cTnT (hscTnT) assay would increase the detection rate of perioperative MI. METHODS: In this ancillary study of the Vitamins in Nitrous Oxide trial, readjudicated incidence rates of myocardial injury (new isolated cTn elevation) and MI were compared when diagnosed by contemporary cTnI versus hscTnT...
July 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28588090/associations-between-cardiac-troponin-mechanism-of-myocardial-injury-and-long-term-mortality-after-noncardiac-vascular-surgery
#2
Grant W Reed, Samuel Horr, Laura Young, Joshua Clevenger, Umair Malik, Stephen G Ellis, A Michael Lincoff, Steven E Nissen, Venu Menon
BACKGROUND: The time-sensitive hazard of perioperative cardiac troponin T (cTnT) elevation and whether long-term mortality differs by mechanism of myocardial injury are poorly understood. METHODS AND RESULTS: In this observational study of 12 882 patients who underwent noncardiac vascular surgery, patients were assessed for cTnT sampling within 96 hours postoperatively. Mortality out to 5-years was stratified by cTnT level and mechanism of myocardial injury. During a median follow-up of 26...
June 6, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28486392/myocardial-injury-after-noncardiac-surgery-mins-in-vascular-surgical-patients-a-prospective-observational-cohort-study
#3
Bruce M Biccard, David Julian Ashbridge Scott, Matthew T V Chan, Andrew Archbold, Chew-Yin Wang, Alben Sigamani, Gerard Urrútia, Patricia Cruz, Sadeesh K Srinathan, David Szalay, John Harlock, Jacques G Tittley, Theodore Rapanos, Fadi Elias, Michael J Jacka, German Malaga, Valsa Abraham, Otavio Berwanger, Félix R Montes, Diane M Heels-Ansdell, Matthew T Hutcherson, Clara K Chow, Carisi A Polanczyk, Wojciech Szczeklik, Gareth L Ackland, Luc Dubois, Robert J Sapsford, Colin Williams, Olga L Cortés, Yannick Le Mananch, P J Devereaux
OBJECTIVE: To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients. BACKGROUND: MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described. METHODS: This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery...
May 8, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28444280/association-of-postoperative-high-sensitivity-troponin-levels-with-myocardial-injury-and-30-day-mortality-among-patients-undergoing-noncardiac-surgery
#4
P J Devereaux, Bruce M Biccard, Alben Sigamani, Denis Xavier, Matthew T V Chan, Sadeesh K Srinathan, Michael Walsh, Valsa Abraham, Rupert Pearse, C Y Wang, Daniel I Sessler, Andrea Kurz, Wojciech Szczeklik, Otavio Berwanger, Juan Carlos Villar, German Malaga, Amit X Garg, Clara K Chow, Gareth Ackland, Ameen Patel, Flavia Kessler Borges, Emilie P Belley-Cote, Emmanuelle Duceppe, Jessica Spence, Vikas Tandon, Colin Williams, Robert J Sapsford, Carisi A Polanczyk, Maria Tiboni, Pablo Alonso-Coello, Atiya Faruqui, Diane Heels-Ansdell, Andre Lamy, Richard Whitlock, Yannick LeManach, Pavel S Roshanov, Michael McGillion, Peter Kavsak, Matthew J McQueen, Lehana Thabane, Reitze N Rodseth, Giovanna A Lurati Buse, Mohit Bhandari, Ignacia Garutti, Michael J Jacka, Holger J Schünemann, Olga Lucía Cortes, Pierre Coriat, Nazari Dvirnik, Fernando Botto, Shirley Pettit, Allan S Jaffe, Gordon H Guyatt
Importance: Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). Objective: To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). Design, Setting, and Participants: Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement...
April 25, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28202201/acute-kidney-injury-is-an-independent-risk-factor-for-myocardial-injury-after-noncardiac-surgery-in-critical-patients
#5
Xiu-Juan Zhao, Feng-Xue Zhu, Shu Li, Hong-Bin Zhang, You-Zhong An
BACKGROUND: Myocardial injury after noncardiac surgery (MINS) contributes to mortality and morbidity. However, risk factors accelerating its development remain unclear. The aim of this study was to identify the incidence and risk factors of MINS. METHODS: A retrospective and observational cohort study of critical patients (n=1087) after noncardiac surgery was carried out at a large and tertiary university hospital from January 2012 to January 2013. The clinical data including medical history as well as intraoperative and postoperative variables were recorded...
June 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28197046/outcome-of-noncardiac-surgical-patients-admitted-to-a-multidisciplinary-intensive-care-unit
#6
Pradeep Kumar, M K Renuka, M S Kalaiselvan, A S Arunkumar
CONTEXT: Surgical procedures carry significant morbidity and mortality depending on the type of surgery and patients. There is a dearth of evidence from India on the outcome of surgical patients admitted to an Intensive Care Unit (ICU). AIMS: We aimed to describe the incidence and risk factors of postoperative complications and mortality in noncardiac surgical patients admitted to the ICU. SETTINGS AND DESIGN: This was a prospective observational study on all perioperative patients admitted to a multidisciplinary ICU for 18 months...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27892891/atorvastatin-for-high-risk-statin-na%C3%A3-ve-patients-undergoing-noncardiac-surgery-the-lowering-the-risk-of-operative-complications-using-atorvastatin-loading-dose-load-randomized-trial
#7
RANDOMIZED CONTROLLED TRIAL
Otavio Berwanger, Pedro G M de Barros E Silva, Roberto Ramos Barbosa, Dalton Bertolim Precoma, Estêvão Lanna Figueiredo, Ludhmila Abrahão Hajjar, Cleber Dario Pinto Kruel, Carolina Alboim, Adail Paixão Almeida, Marianna Deway Andrade Dracoulakis, Hugo Vargas Filho, Maria José Carvalho Carmona, Lília Nigro Maia, João Bosco de Oliveira Filho, Jose Francisco Kerr Saraiva, Rafael M Soares, Lucas Damiani, Denise Paisani, Alessandra A Kodama, Beatriz Gonzales, Dimas T Ikeoka, Philip J Devereaux, Renato D Lopes
Preliminary evidence suggests that statins may prevent major perioperative vascular complications. METHODS: We randomized 648 statin-naïve patients who were scheduled for noncardiac surgery and were at risk for a major vascular complication. Patients were randomized to a loading dose of atorvastatin or placebo (80 mg anytime within 18hours before surgery), followed by a maintenance dose of 40 mg (or placebo), started at least 12hours after the surgery, and then 40 mg/d (or placebo) for 7days...
February 2017: American Heart Journal
https://www.readbyqxmd.com/read/27870734/incremental-value-of-preoperative-copeptin-for-predicting-myocardial-injury
#8
RANDOMIZED CONTROLLED TRIAL
Eckhard Mauermann, Daniel Bolliger, Esther Seeberger, Christian Puelacher, Sydney Corbiere, Miodrag Filipovic, Manfred Seeberger, Christian Mueller, Giovanna Lurati Buse
BACKGROUND: Copeptin, a novel marker of endogenous stress, has shown diagnostic and prognostic value in nonsurgical patients with a suspected coronary event. We aimed to assess the incremental value of copeptin in addition to established preoperative risk indices to predict the occurrence of postoperative myocardial injury. METHODS: This secondary analysis of prospectively collected data included adults undergoing noncardiac surgery with risk factors for adverse perioperative cardiac events based on preoperative risk stratification...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27865641/canadian-cardiovascular-society-guidelines-on-perioperative-cardiac-risk-assessment-and-management-for-patients-who-undergo-noncardiac-surgery
#9
Emmanuelle Duceppe, Joel Parlow, Paul MacDonald, Kristin Lyons, Michael McMullen, Sadeesh Srinathan, Michelle Graham, Vikas Tandon, Kim Styles, Amal Bessissow, Daniel I Sessler, Gregory Bryson, P J Devereaux
The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27792044/relationship-between-intraoperative-hypotension-defined-by-either-reduction-from-baseline-or-absolute-thresholds-and-acute-kidney-and-myocardial-injury-after-noncardiac-surgery-a-retrospective-cohort-analysis
#10
Vafi Salmasi, Kamal Maheshwari, Dongsheng Yang, Edward J Mascha, Asha Singh, Daniel I Sessler, Andrea Kurz
BACKGROUND: How best to characterize intraoperative hypotension remains unclear. Thus, the authors assessed the relationship between myocardial and kidney injury and intraoperative absolute (mean arterial pressure [MAP]) and relative (reduction from preoperative pressure) MAP thresholds. METHODS: The authors characterized hypotension by the lowest MAP below various absolute and relative thresholds for cumulative 1, 3, 5, or 10 min and also time-weighted average below various absolute or relative MAP thresholds...
January 2017: Anesthesiology
https://www.readbyqxmd.com/read/27775997/withholding-versus-continuing-angiotensin-converting-enzyme-inhibitors-or-angiotensin-ii-receptor-blockers-before-noncardiac-surgery-an-analysis-of-the-vascular-events-in-noncardiac-surgery-patients-cohort-evaluation-prospective-cohort
#11
COMPARATIVE STUDY
Pavel S Roshanov, Bram Rochwerg, Ameen Patel, Omid Salehian, Emmanuelle Duceppe, Emilie P Belley-Côté, Gordon H Guyatt, Daniel I Sessler, Yannick Le Manach, Flavia K Borges, Vikas Tandon, Andrew Worster, Alexandra Thompson, Mithin Koshy, Breagh Devereaux, Frederick A Spencer, Robert D Sanders, Erin N Sloan, Erin E Morley, James Paul, Karen E Raymer, Zubin Punthakee, P J Devereaux
BACKGROUND: The effect on cardiovascular outcomes of withholding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in chronic users before noncardiac surgery is unknown. METHODS: In this international prospective cohort study, the authors analyzed data from 14,687 patients (including 4,802 angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker users) at least 45 yr old who had in-patient noncardiac surgery from 2007 to 2011...
January 2017: Anesthesiology
https://www.readbyqxmd.com/read/27732551/kinetics-of-troponin-i-in-patients-with-myocardial-injury-after-noncardiac-surgery
#12
Judith A R van Waes, Linda M Peelen, Hans Kemperman, Remco B Grobben, Hendrik M Nathoe, Wilton A van Klei
BACKGROUND: Myocardial injury after noncardiac surgery, as measured by troponin elevation, is strongly associated with mortality. However, it is unknown in which patients prognosis can be improved. The presence of kinetic changes of troponin may be associated with a worse prognosis and warrant more aggressive management. Therefore, we aimed to study the kinetics of troponin in patients with postoperative myocardial injury, and to determine the added predictive value of kinetic changes of troponin on mortality...
March 1, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/27687420/surgical-apgar-score-is-associated-with-myocardial-injury-after-noncardiac-surgery
#13
L McLean House, Khensani N Marolen, Paul J St Jacques, Matthew D McEvoy, Jesse M Ehrenfeld
STUDY OBJECTIVE: To assess the impact of intraoperative hemodynamics in the development of perioperative myocardial infarction (MI) and myocardial ischemia after noncardiac surgery. DESIGN: Single-center retrospective cohort study of surgical patients from 2007 to 2012. SETTING: Postanesthesia care unit, intensive care unit, and medical-surgical ward at an academic tertiary medical center. PATIENTS: A total of 46,799 adult noncardiac, nonthoracic surgery patients, for which 2290 peak cardiac troponin (cTn) levels were available...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27331782/perioperative-troponin-screening
#14
Daniel I Sessler, P J Devereaux
Myocardial injury is the most common cause of death during the 30 days after noncardiac surgery. Only 14% of patients who are experiencing a perioperative myocardial infarction will have chest pain, and 65% are entirely clinically silent, which means that they will go undetected without routine troponin screening. Although it is tempting to dismiss asymptomatic troponin elevation, mortality is similar with and without symptoms. Furthermore, mortality at 30 days in patients who have postoperative troponin elevation is a concerning 10%, which represents a 5-fold increase from background risk...
August 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27258663/postoperative-complications-in-cardiac-patients-undergoing-noncardiac-surgery
#15
Stefan De Hert, Annelies Moerman, Luc De Baerdemaeker
PURPOSE OF REVIEW: In this article we review the current knowledge on the underlying mechanisms of perioperative myocardial injury, the preoperative methods of predicting these complications, the diagnostic tools for detecting perioperative myocardial injuries, and the available protective strategies to prevent or attenuate the extent of myocardial injury. RECENT FINDINGS: The last years' new insights have provided a better understanding of the problem of perioperative myocardial injury and infarction...
August 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27150001/troponin-i-level-after-major-noncardiac-surgery-and-its-association-with-long-term-mortality
#16
Minkwan Kim, Minkook Son, Dong Hyun Lee, Kyungil Park, Tae-Ho Park
Individuals with intermediate to high cardiac risk for major noncardiac surgery suffer from perioperative myocardial ischemic injury. The purpose of this study was to evaluate the long-term impact of postoperative cardiac troponin elevation on clinical outcome after major noncardiac surgery.Patients (n = 750) aged ≥ 50 years who underwent major noncardiac surgery were eligible for the study. Postoperative cardiac troponin-I data were collected retrospectively and consecutively. The primary outcome measure was allcause mortality...
May 25, 2016: International Heart Journal
https://www.readbyqxmd.com/read/27111647/one-year-mortality-causes-of-death-and-cardiac-interventions-in-patients-with-postoperative-myocardial-injury
#17
Judith A R van Waes, Remco B Grobben, Hendrik M Nathoe, Hans Kemperman, Gert Jan de Borst, Linda M Peelen, Wilton A van Klei
BACKGROUND: To evaluate the role of routine troponin surveillance in patients undergoing major noncardiac surgery, unblinded screening with cardiac consultation per protocol was implemented at a tertiary care center. In this study, we evaluated 1-year mortality, causes of death, and consequences of cardiac consultation of this protocol. METHODS: This observational cohort included 3224 patients ≥60 years old undergoing major noncardiac surgery. Troponin I was measured routinely on the first 3 postoperative days...
July 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27008065/myocardial-injury-after-noncardiac-surgery-an-underappreciated-problem-and-current-challenges
#18
Eckhard Mauermann, Christian Puelacher, Giovanna Lurati Buse
PURPOSE OF REVIEW: To review myocardial injury after noncardiac surgery (MINS), focusing on recent studies, including data on high-sensitivity troponin, which is likely to alter our understanding of MINS. RECENT FINDINGS: MINS is greatly underappreciated by clinicians, possibly because of its silent presentation. However, MINS is both common and clinically important. In total, 8% of at-risk patients will suffer a MINS, an event that is associated with death within 30 days with an odds ratio of 3...
June 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/26779857/interarm-systolic-blood-pressure-difference-is-associated-with-myocardial-injury-after-noncardiac-surgery
#19
Erdal Belen, Ender Ozal, Akif Bayyigit, Senay Gunaydın, Aysen Helvacı
BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) is closely related to increased cardiovascular mortality. AIM: To evaluate the relationship between MINS and interarm systolic blood pressure difference (IASBPD), which has previously been shown to correlate with the frequency of cardiovascular events and arterial arteriosclerotic processes. METHODS: This observational, single-centre cohort study included 240 consecutive noncardiac surgery patients aged ≥ 45 years...
2016: Kardiologia Polska
https://www.readbyqxmd.com/read/26599804/perioperative-myocardial-infarction-injury-after-noncardiac-surgery
#20
REVIEW
Christian Puelacher, Giovanna Lurati-Buse, Hélène Singeisen, Minh Dang, Florim Cuculi, Christian Müller
Cardiovascular complications, particularly perioperative myocardial infarction/injury, seem to be major contributors to mortality after noncardiac surgery. With surgical procedures being very frequent (900 000/year in Switzerland), perioperative myocardial injury is common in everyday clinical practice. Over 80% of patients experiencing perioperative myocardial injury do not report symptoms. Therefore perioperative myocardial injury remains undiagnosed and untreated. Moreover, its silent presentation results in limited awareness among both clinicians and the public...
2015: Swiss Medical Weekly
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