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Myocardial Injury after Noncardiac Surgery

W Scott Beattie, Duminda N Wijeysundera, Matthew T V Chan, Philip J Peyton, Kate Leslie, Michael J Paech, Daniel I Sessler, Sophie Wallace, Paul S Myles, W Galagher, C Farrington, A Ditoro, S Baulch, S Sidiropoulos, R Bulach, D Bryant, E O'Loughlin, V Mitteregger, S Bolsin, C Osborne, R McRae, M Backstrom, R Cotter, S March, B Silbert, S Said, R Halliwell, J Cope, D Fahlbusch, D Crump, G Thompson, A Jefferies, M Reeves, N Buckley, T Tidy, T Schricker, R Lattermann, D Iannuzzi, J Carroll, M Jacka, C Bryden, N Badner, M W Y Tsang, B C P Cheng, A C M Fong, L C Y Chu, E G Y Koo, N Mohd, L E Ming, D Campbell, D McAllister, S Walker, S Olliff, R Kennedy, A Eldawlatly, T Alzahrani, N Chua, R Sneyd, H McMillan, I Parkinson, A Brennan, P Balaji, J Nightingale, G Kunst, M Dickinson, B Subramaniam, V Banner-Godspeed, J Liu, A Kurz, B Hesler, A Y Fu, C Egan, A N Fiffick, M T Hutcherson, A Turan, A Naylor, D Obal, E Cooke
BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk...
March 12, 2018: Anesthesia and Analgesia
Gündüz Durmuş, Erdal Belen, Mehmet Mustafa Can
BACKGROUND: The neutrophil to lymphocyte ratio (NLR), has been proposed as potential indicator of cardiovascular events. Our aim was to determine the relationship between NLR and development of myocardial injury after non-cardiac surgery (MINS). METHODS: This observational cohort study included 255 consecutive noncardiac surgery patients aged ≥45 years. Electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels of the patients were obtained for a period of 3 days postoperatively...
February 27, 2018: Heart & Lung: the Journal of Critical Care
Emmanuelle Duceppe, Salim Yusuf, Vikas Tandon, Reitze Rodseth, Bruce M Biccard, Denis Xavier, Wojciech Szczeklik, Christian S Meyhoff, Maria Grazia Franzosi, Jessica Vincent, Sadeesh K Srinathan, Joel Parlow, Patrick Magloire, John Neary, Mangala Rao, Navneet K Chaudhry, Bongani Mayosi, Miriam de Nadal, Ekaterine Popova, Juan Carlos Villar, Fernando Botto, Otavio Berwanger, Gordon Guyatt, John W Eikelboom, Daniel I Sessler, Clive Kearon, Shirley Pettit, Stuart J Connolly, Mukul Sharma, Shrikant I Bangdiwala, P J Devereaux
BACKGROUND: Worldwide approximately 200 million adults undergo major surgery annually, of whom 8 million are estimated to suffer a myocardial injury after noncardiac surgery (MINS). There is currently no trial data informing the management of MINS. Antithrombotic agents such as direct oral anticoagulants might prevent major vascular complications in patients with MINS. METHODS: The Management of Myocardial Injury After Noncardiac Surgery (MANAGE) trial is a large international blinded randomized controlled trial of dabigatran vs placebo in patients who suffered MINS...
February 2, 2018: Canadian Journal of Cardiology
F van Lier, F H I M Wesdorp, V G B Liem, J W Potters, F Grüne, H Boersma, R J Stolker, S E Hoeks
BACKGROUND: Myocardial injury after noncardiac surgery is common, although the exact pathophysiology is unknown. It is plausible that hypotension after surgery is relevant for the development of myocardial injury. The authors evaluated whether low mean arterial pressures (MAPs) after surgery are related to an increased incidence in postoperative cardiac-troponin elevation. METHODS: A prospective cohort of 2211 patients aged ≥60 yr, undergoing major or moderate noncardiac surgery in The Netherlands, was retrospectively analysed for the occurrence of postoperative cardiac-troponin elevation [high-sensitive troponin T (hsTnT) >14 ng L-1 ]...
January 2018: British Journal of Anaesthesia
Christian Puelacher, Giovanna Lurati Buse, Daniela Seeberger, Lorraine Sazgary, Stella Marbot, Andreas Lampart, Jaqueline Espinola, Christoph Kindler, Angelika Hammerer, Esther Seeberger, Ivo Strebel, Karin Wildi, Raphael Twerenbold, Jeanne du Fay de Lavallaz, Luzius Steiner, Lorenz Gurke, Tobias Breidthardt, Katharina Rentsch, Andreas Buser, Danielle M Gualandro, Stefan Osswald, Christian Mueller
Background -Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening. Methods -We performed a prospective diagnostic study enrolling consecutive patients undergoing noncardiac surgery who had a planned postoperative stay of ≥24 hours and were considered at increased cardiovascular risk. All patients received a systematic screening using serial measurements of high-sensitivity cardiac troponin T in clinical routine...
December 4, 2017: Circulation
Remco B Grobben, Judith A R van Waes, Tim Leiner, Linda M Peelen, Gert Jan de Borst, Henri C Vogely, Diederick E Grobbee, Pieter A Doevendans, Wilton A van Klei, Hendrik M Nathoe
BACKGROUND: Postoperative myocardial injury (PMI) is a strong predictor of mortality after noncardiac surgery. PMI is believed to be attributable to coronary artery disease (CAD), yet its etiology is largely unclear. We aimed to quantify the prevalence of significant CAD in patients with and without PMI using coronary computed tomography angiography (CCTA). METHODS: This prospective cohort study included patients of 60 years or older without a history of cardiac disease and with and without PMI after intermediate- to high-risk noncardiac surgery...
November 1, 2017: Anesthesia and Analgesia
Tom E F Abbott, Rupert M Pearse, R Andrew Archbold, Tahania Ahmad, Edyta Niebrzegowska, Andrew Wragg, Reitze N Rodseth, Philip J Devereaux, Gareth L Ackland
BACKGROUND: The association between intraoperative cardiovascular changes and perioperative myocardial injury has chiefly focused on hypotension during noncardiac surgery. However, the relative influence of blood pressure and heart rate (HR) remains unclear. We investigated both individual and codependent relationships among intraoperative HR, systolic blood pressure (SBP), and myocardial injury after noncardiac surgery (MINS). METHODS: Secondary analysis of the Vascular Events in Noncardiac Surgery Cohort Evaluation (VISION) study, a prospective international cohort study of noncardiac surgical patients...
October 26, 2017: Anesthesia and Analgesia
Xavier Chapalain, Olivier Huet
No abstract text is available yet for this article.
August 2017: Journal of Thoracic Disease
Dennis W Regan, Deanne Kashiwagi, Brian Dougan, Karna Sundsted, Karen Mauck
This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. We set out to identify, critically review, and summarize key evidence which has the most potential for practice change...
October 2017: Hospital Practice (Minneapolis)
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...
November 2017: Anesthesia and Analgesia
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
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
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
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
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
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
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
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
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
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
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