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Myocardial infarction noncardiac surgery

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https://www.readbyqxmd.com/read/28385315/use-of-antiplatelet-therapy-dapt-for%C3%A2-post-pci-patients-undergoing-noncardiac-surgery
#1
REVIEW
Subhash Banerjee, Dominick J Angiolillo, William E Boden, Joseph G Murphy, Houman Khalili, Ahmed A Hasan, Robert A Harrington, Sunil V Rao
Dual antiplatelet therapy (DAPT) is prescribed to millions of patients worldwide following coronary stenting. DAPT is indicated to lower the risk of ischemic events, such as myocardial infarction, including stent thrombosis, ischemic stroke, or death from cardiovascular causes. A significant number of these patients undergo noncardiac surgery and may require DAPT interruption. This poses a significant clinical dilemma because DAPT interruption exposes patients to the potential risk of stent thrombosis, perioperative myocardial infarction, or both...
April 11, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28376710/electrocardiographic-changes-mimicking-acute-coronary-syndrome-in-a-large-intracranial-tumour-a-diagnostic-dilemma
#2
Nilukshana Yogendranathan, H M M T B Herath, S P Pahalagamage, Aruna Kulatunga
BACKGROUND: ST elevation Myocardial infarction is a medical emergency. A variety of noncardiac conditions had been known to mimic the ECG changes that are seen in acute coronary syndrome. Although the common ECG changes that are documented with raised intracranial pressure are T inversions, prolongation of QT interval and sinus bradycardia, ST elevation or depression, arrhythmias and prominent U waves have also been recognized. However, ST elevations in association with primary intracranial tumours are rarely reported...
April 4, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28366317/morbidity-and-mortality-in-elective-total-hip-arthroplasty-following-surgical-care-improvement-project-guidelines
#3
Thomas B Bemenderfer, Nigel L Rozario, Charity G Moore, Madhav A Karunakar
BACKGROUND: Following evidence questioning the safety and efficacy of perioperative beta-blocker therapy in noncardiac surgery, the Surgical Care Improvement Project (SCIP) guidelines were retired in 2015. However, perioperative myocardial infarctions and cardiac complications remain leading causes of mortality following noncardiac surgery. The impact of the SCIP guidelines on reducing cardiac complications in patients undergoing elective total hip arthroplasty (THA) has not been evaluated...
March 9, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28207554/isolated-cardiac-troponin-rise-does-not-modify-the-prognosis-in-elderly-patients-with-hip-fracture
#4
Hélène Vallet, Alice Breining, Yannick Le Manach, Judith Cohen-Bittan, Anthony Mézière, Mathieu Raux, Marc Verny, Bruno Riou, Frédéric Khiami, Jacques Boddaert
Perioperative myocardial infarction remains a life-threatening complication in noncardiac surgery and even an isolated troponin rise (ITR) is associated with significant mortality. Our aim was to assess the prognostic value of ITR in elderly patients with hip fracture.In this cohort study, all patients admitted between 2009 and 2013 in our dedicated geriatric postoperative unit after hip fracture surgery with a cardiac troponin I determination were included and divided into Control, ITR, and acute coronary syndrome (ACS) groups...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28197046/outcome-of-noncardiac-surgical-patients-admitted-to-a-multidisciplinary-intensive-care-unit
#5
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/28161261/incomplete-revascularization-is-associated-with-an-increased-risk-for%C3%A2-major-adverse-cardiovascular-events%C3%A2-among-patients-undergoing-noncardiac-surgery
#6
Ehrin J Armstrong, Laura A Graham, Stephen W Waldo, Javier A Valle, Thomas M Maddox, Mary T Hawn
OBJECTIVES: The aim of this study was to determine whether incomplete revascularization is associated with a higher risk for major adverse cardiovascular events (MACE) and myocardial infarction (MI) among patients undergoing noncardiac surgery. BACKGROUND: Patients with coronary artery disease and prior percutaneous coronary intervention (PCI) frequently undergo noncardiac surgery. These patients may have had PCI either on all obstructive lesions (i.e., complete revascularization) or only on some (i...
February 27, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28032851/is-perioperative-beta-blockade-effective-and-safe-in-patients-undergoing-noncardiac-surgery
#7
Andrés Armstrong, Gabriel Rada, Fernando Altermatt
Beta-blockade in patients undergoing noncardiac surgery has been widely recommended as a way to reduce cardiovascular adverse events during the perioperative period. However, studies have shown contradictory results. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified 22 systematic reviews comprising 131 studies addressing the question of this article, including 112 randomized trials. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach...
December 27, 2016: Medwave
https://www.readbyqxmd.com/read/28030663/perioperative-major-adverse-cardiovascular-and-cerebrovascular-events-associated-with-noncardiac-surgery
#8
Nathaniel R Smilowitz, Navdeep Gupta, Harish Ramakrishna, Yu Guo, Jeffrey S Berger, Sripal Bangalore
Importance: Major adverse cardiovascular and cerebrovascular events (MACCE) are a significant source of perioperative morbidity and mortality following noncardiac surgery. Objective: To evaluate national trends in perioperative cardiovascular outcomes and mortality after major noncardiac surgery and to identify surgical subtypes associated with cardiovascular events using a large administrative database of United States hospital admissions. Design, Setting, Participants: Patients who underwent major noncardiac surgery from January 2004 to December 2013 were identified using the National Inpatient Sample...
February 1, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/28002165/improving-prediction-of-postoperative-myocardial-infarction-with-high-sensitivity-cardiac-troponin-t-and-nt-probnp
#9
Michael Kopec, Andreas Duma, Mohammad A Helwani, Jamie Brown, Frank Brown, Brian F Gage, David W Gibson, J Philip Miller, Eric Novak, Allan S Jaffe, Fred S Apple, Mitchell G Scott, Peter Nagele
BACKGROUND: This study sought to determine whether preoperatively measured high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) improve cardiac risk prediction in patients undergoing major noncardiac surgery compared with the standard risk indices. METHODS: In this ancillary study to the Vitamins in Nitrous Oxide trial, patients were included who had preoperative hs-cTnT and NT-proBNP measured (n = 572). Study outcome was the incidence of postoperative myocardial infarction (MI) within the first 3 postoperative days...
February 2017: Anesthesia and Analgesia
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
#10
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/27865641/canadian-cardiovascular-society-guidelines-on-perioperative-cardiac-risk-assessment-and-management-for-patients-who-undergo-noncardiac-surgery
#11
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/27687420/surgical-apgar-score-is-associated-with-myocardial-injury-after-noncardiac-surgery
#12
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/27663179/clinical-outcomes-associated-with-per-operative-discontinuation-of-aspirin-in-patients-with-coronary-artery-disease-a-systematic-review-and-meta-analysis
#13
Faraz Khan Luni, Haris Riaz, Abdur Rahman Khan, Talha Riaz, Muhammad Husnain, Irbaz Bin Riaz, Muhammad Shahzeb Khan, Mohammed Taleb, Yusuf Kanjwal, Christopher J Cooper, Sadik A Khuder
BACKGROUND: Postoperative state is characterized by increased thrombotic risk by virtue of platelet activation. Whether aspirin ameliorates this risk in patients with established coronary artery disease undergoing cardiac or noncardiac surgery is unknown. We conducted a systematic review and meta-analysis to compare the risk of major adverse cardiac events (MACE) and the risk of bleeding in patients with early (3-5 or more days before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of aspirin...
September 24, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27640120/coronary-angiography-and-failure-to-rescue-after-postoperative-myocardial-infarction-in-patients-with-coronary-stents-undergoing-noncardiac-surgery
#14
COMPARATIVE STUDY
Robert H Hollis, Carla N Holcomb, Javier A Valle, Burke P Smith, Aerin J DeRussy, Laura A Graham, Joshua S Richman, Kamal M F Itani, Thomas M Maddox, Mary T Hawn
BACKGROUND: We evaluated coronary angiography use among patients with coronary stents suffering postoperative myocardial infarction (MI) and the association with mortality. METHODS: Patients with prior coronary stenting who underwent inpatient noncardiac surgery in Veterans Affairs hospitals between 2000 and 2012 and experienced postoperative MI were identified. Predictors of 30-day post-MI mortality were evaluated. RESULTS: Following 12,096 operations, 353 (2...
November 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27631445/-the-perioperative-myocardial-infarction-an-interdisciplinary-task
#15
Konstantinos Karatolios, Caroline Rolfes, Hinnerk Wulf, Bernhard Schieffer
Cardiovascular complications, particularly perioperative myocardial infarction (PMI), are major contributors to mortaliyt after noncardiac surgery. PMI often occurs unnoticed without symptoms or ECG changes. Despite ist silent presentation, PMI is associated with increased mortality. The combination of high associated mortality and diagnostic challenges mandates increased awareness of PMI. Perioperative myocardial infarction may result from plaque rupture (PMI type I) or be caused by a myocardial supply-demand imbalance of oxygen without plaque rupture (PMI type II)...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/27486311/simultaneous-surgery-in-patients-with-both-cardiac-and-noncardiac-diseases
#17
Yang Yang, Feng Xiao, Jin Wang, Bo Song, Xi-Hui Li, Jian Li, Zhi-Song He, Huan Zhang, Ling Yin
BACKGROUND: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery. METHODS: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries. RESULTS: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG), bladder cystectomy, and ureterostomy...
2016: Patient Preference and Adherence
https://www.readbyqxmd.com/read/27443427/percutaneous-intervention-for-myocardial-infarction-after-noncardiac-surgery-patient-characteristics-and-outcomes
#18
Akhil Parashar, Shikhar Agarwal, Amar Krishnaswamy, Karan Sud, Kanhaiya L Poddar, Mehak Bassi, Stephen Ellis, E Murat Tuzcu, Venu Menon, Samir R Kapadia
BACKGROUND: Few studies have explored percutaneous coronary intervention (PCI) in perioperative myocardial infarction (PMI), even though PMI is a major cause of mortality in patients undergoing urgent/emergent noncardiac surgery. OBJECTIVES: This study sought to describe the angiographic characteristics and outcomes in patients presenting to the cardiac catheterization laboratory for myocardial infarction sustained after undergoing noncardiac surgery, with a detailed analysis of those undergoing PCI...
July 26, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27433900/troponin-elevation-after-colorectal-surgery-significance-and-management
#19
Emre Gorgun, Billy Y Lan, H Hande Aydinli, Grant W Reed, Venu Menon, Daniel I Sessler, Luca Stocchi, Feza H Remzi
OBJECTIVE: The aim of this study is to identify the association between early postoperative troponin elevations and outcomes after major colorectal surgery. BACKGROUND: Myocardial infarction is the leading cause of death after noncardiac surgery. Most postoperative myocardial infarctions are clinically silent, and asymptomatic troponin elevations have the same early mortality as symptomatic infarctions. METHODS: Patients over the age of 45, undergoing major colorectal surgery from March 2015 to January 2016, were identified...
October 2016: Annals of Surgery
https://www.readbyqxmd.com/read/27404797/antiplatelet-therapy-and-outcome-in-patients-undergoing-surgery-following-coronary-stenting-results-of-the-surgery-after-stenting-registry
#20
MULTICENTER STUDY
Roberta Rossini, Dominick J Angiolillo, Giuseppe Musumeci, Davide Capodanno, Maddalena Lettino, Daniela Trabattoni, Annarita Pilleri, Paolo Calabria, Paola Colombo, Paola Bernabò, Marco Ferlini, Marco Ferri, Giuseppe Tarantini, Stefano De Servi, Stefano Savonitto
OBJECTIVES: The aim of the present study was to define the feasibility and clinical impact of complying with national consensus recommendations on perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and noncardiac surgery. BACKGROUND: There are limited evidence-based recommendations on the perioperative management of antiplatelet therapy in stented patients undergoing surgery. METHODS: The recommendations provided by the national consensus document were applied in a multicenter, prospective registry of consecutive patients with prior coronary stenting undergoing any type of surgery at 19 hospitals in Italy...
January 2017: Catheterization and Cardiovascular Interventions
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