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Myocardial Injury after Noncardiac Surgery

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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
#1
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...
November 9, 2016: 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
#2
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...
October 4, 2016: 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
#3
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 (intraoperative 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...
October 28, 2016: 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
#4
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...
October 24, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27732551/kinetics-of-troponin-i-in-patients-with-myocardial-injury-after-noncardiac-surgery
#5
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...
October 12, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/27687420/surgical-apgar-score-is-associated-with-myocardial-injury-after-noncardiac-surgery
#6
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/27433900/troponin-elevation-after-colorectal-surgery-significance-and-management
#7
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/27331782/perioperative-troponin-screening
#8
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/27150001/troponin-i-level-after-major-noncardiac-surgery-and-its-association-with-long-term-mortality
#9
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
#10
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
#11
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
#12
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
#13
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
https://www.readbyqxmd.com/read/26540148/association-between-intraoperative-hypotension-and-myocardial-injury-after-vascular-surgery
#14
MULTICENTER STUDY
Judith A R van Waes, Wilton A van Klei, Duminda N Wijeysundera, Leo van Wolfswinkel, Thomas F Lindsay, W Scott Beattie
BACKGROUND: Postoperative myocardial injury occurs frequently after noncardiac surgery and is strongly associated with mortality. Intraoperative hypotension (IOH) is hypothesized to be a possible cause. The aim of this study was to determine the association between IOH and postoperative myocardial injury. METHODS: This cohort study included 890 consecutive patients aged 60 yr or older undergoing vascular surgery from two university centers. The occurrence of myocardial injury was assessed by troponin measurements as part of a postoperative care protocol...
January 2016: Anesthesiology
https://www.readbyqxmd.com/read/26384628/is-preoperative-endothelial-dysfunction-a-potentially-modifiable-risk-factor-for-renal-injury-associated-with-noncardiac-surgery
#15
MULTICENTER STUDY
David R McIlroy, Matthew T V Chan, Sophie K Wallace, Arvinder Grover, Emily G Y Koo, Jiajia Ma, Joel A Symons, Paul S Myles
OBJECTIVES: To determine whether preoperative endothelial dysfunction provides risk stratification for perioperative renal injury in patients undergoing noncardiac surgery. The relationship between perioperative renal injury and myocardial injury after noncardiac surgery (MINS) was explored secondarily. DESIGN: An observational study. SETTING: Two academic medical centers. PARTICIPANTS: A total of 218 patients scheduled to undergo intermediate or high-risk noncardiac surgery...
October 2015: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/25977993/variability-of-automated-intraoperative-st-segment-values-predicts-postoperative-troponin-elevation
#16
Michael D Maile, Milo C Engoren, Kevin K Tremper, Theodore T Tremper, Elizabeth S Jewell, Sachin Kheterpal
BACKGROUND: Intraoperative electrocardiographic monitoring is considered a standard of care. However, there are no evidence-based algorithms for using intraoperative ST segment data to identify patients at high risk for adverse perioperative cardiac events. Therefore, we performed an exploratory study of statistical measures summarizing intraoperative ST segment values determine whether the variability of these measurements was associated with adverse postoperative events. We hypothesized that elevation, depression, and variability of ST segments captured in an anesthesia information management system are associated with postoperative serum troponin elevation...
March 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/25512282/-analysis-of-risk-factors-associated-with-weaning-from-mechanical-ventilation-in-critical-patients-with-major-abdominal-surgery
#17
S Li, Y Z An, J Y Ren, F X Zhu, H Chen
OBJECTIVE: To analyze the risk factors involved in the weaning from mechanical ventilation in critical patients who underwent major abdominal surgery. METHODS: This retrospective study was conducted at Department of Critical Care Medicine in Peking University People's Hospital. The subjects included all critical ill patients who underwent major abdominal surgery from January 2011 to December 2013. Clinical and laboratory parameters in perioperative period were investigated for the risk factors involved in the weaning from mechanical ventilation...
December 18, 2014: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
https://www.readbyqxmd.com/read/25498191/meta-analysis-of-the-effects-of-statins-on-perioperative-outcomes-in-vascular-and-endovascular-surgery
#18
REVIEW
George A Antoniou, Shahin Hajibandeh, Shahab Hajibandeh, Srinivasa Rao Vallabhaneni, John A Brennan, Francesco Torella
BACKGROUND: Compelling evidence from large randomized trials demonstrates the salutary effects of statins on primary and secondary protection from adverse cardiovascular events in high-risk populations. Our objective was to investigate the role of perioperative statin therapy in noncardiac vascular and endovascular surgery. METHODS: Electronic information sources were systematically searched to identify studies comparing outcomes after noncardiac surgical or endovascular arterial reconstruction in patients who were and were not taking statin in the perioperative or peri-interventional period...
February 2015: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/25229470/novel-insights-into-the-role-of-anesthetics-and-opioids-in-organ-or-tissue-protection
#19
EDITORIAL
Hiroyuki Kinoshita
No abstract text is available yet for this article.
2014: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/25216396/lack-of-association-between-carotid-artery-stenosis-and-stroke-or-myocardial-injury-after-noncardiac-surgery-in-high-risk-patients
#20
Abraham Sonny, Heather L Gornik, Dongsheng Yang, Edward J Mascha, Daniel I Sessler
BACKGROUND: Whether carotid artery stenosis predicts stroke after noncardiac surgery remains unknown. We therefore tested the primary hypothesis that degree of carotid artery stenosis is associated with in-hospital stroke or 30-day all-cause mortality after noncardiac surgery. As carotid artery stenosis is also a marker for cardiovascular disease, our secondary hypothesis was that degree of carotid artery stenosis is associated with postoperative myocardial injury. METHODS: We included adults who had noncardiac, noncarotid surgery at Cleveland Clinic from 2007 to 2011 and had carotid duplex ultrasound performed either within 6 months before or 1 month after surgery...
November 2014: Anesthesiology
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