1. Myocardial Injury after Noncardiac Surgery
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Pierre Coriat, Patricia Cruz, Bogusz Kaczmarek, Gabriel Cusati, Wendy Lim, Saeed Darvish-Kazim, Rupert Pearse, Finlay A. McAlister, Cheryl Ramballi, Robert C M Stephens, R.M. Pearse, Jeff Weitz, Germán Málaga, Alexander Y. Fu, Eleanor McAlees, Alberto Varela, Maria Palencia, James Zacharias, Ryan J. J. Amadeo, Bruce M Biccard, Janet Woods, Catherine M. Clase, Patrick S Finnegan, Laura Gallego Paredes, Alistair Hall, Mariana Vargas Furtado, Alben Sigamani, José Villamor, Alex Torborg, Maria De Los Angeles Lazo, Tony Gin, Pavel S Roshanov, Carmen Fernández, Andrea Kurz, Hertzel C. Gerstein, Stephen Li, R.N. Rodseth, P. Naidoo, Mitchell Winemaker, Parminder Raina, Gordon Y.S. Choi, Lalita Afzal, Richard Mizera, Sean M. Bagshaw, Marta Januszewska, Yannick LeManach, Sultana Furruqh, Robert J. Sapsford, Peter Lovrics, B M Biccard, Cecilia Martínez, Faisal Siddiqui, J. Mooney, Carisi Anne Polanczyk, Ina Ismiarti Shariffuddin, Mark Crowther, Elizabeth Ling, Adrià Font, Mark Soth, Maria Stella Chaparro, Maria José Membrillo, Ekaterina Popova, Denis Monneret, Richard P. Whitlock, Amit Garg, Andrew Archbold, Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (Vision) Investigators, M Leuwer, Vincent W. Lee, Zhuo Sun, Patricia Piñeiro, César A. Jardim, Clare D. Ramsey, Krit Panjasawatwong, James Paul, David W. Gibson, Philip St John, Peter Nagele, Jose Amalth do Espirirto Santo, Pablo Alonso-Coello, Jacek Musial, Jacques G. Tittley, Fernando Botto, Georges Daas, Hou Yee Lai, Ana Gutierrez del Arroyo, Edmunds Reineks, Martin Leuwer, Clive Kearon, Jane Blood, Mari Luz Maestre, Neesh Pannu, Marta De Antonio, Ameen Patel, Aida Rotta-Rotta, Noorjahan Haneem Md Hashim, Amal Bessissow, Hélio Penna Guimarães, Norman Buckley, Mateusz Kózka, Maria José Ferré, Gerard Urrútia, Lydia C.W. Lit, Matthew T. V. Chan, Philip J. Devereaux, Ushananthini Ki, Jesús Alvarez García, Shaveta Mala, Juan Carlos Villar, Andrew McKay, Silvia Moreira Ayub Ferreira, Angeles de Miguel, Gordon H. Guyatt, David Orozco, A. Rushton, Michael J Jacka, Holger J Schünemann, Diane Heels-Ansdell, Guillaume Paré, Stephen Hill, Amit X Garg, Hooman Honar, Pervez Sultan, Miquel Santaló, Zubin Punthakee, Sihe Wang, Katia R. M. Leite, Holger Schünemann, Hilary P Grocott, Aram Shahinyan, Sebastian Ribas, Jackie Bosch, Amanda Smith, Giovanna Luratibuse, Joseph Cherian, Maciej Chwała, Heather McDonald, Rey R. Acedillo, Manuel Muñoz, Sally Benton, Michael Walsh, Vikas Tandon, Shirley Pettit, Javier D Loza-Herrera, Paul M. O'Bryne, Joanne Fletcher, Richard Halliwell, Clara K Chow, Jacek Górka, Michelle M. Graham, Alvaro Castañeda, Ainslie Hildebrand, Patrick Magloire, Skarlett Vásquez, Gareth L Ackland, P. George, Sergio Mazzadi, Susannah Howard, Simon J. Howell, Rubeshan Naidoo, William Orovan, Megan Kalin, Anna Reyes, Anthony Adili, Frederick A. Spencer, Laurel Thorlacius, Jehonathan H. Pinthus, Michaela Lobley, Justin DeBeer, Theroshnie Kisten, Dean Gopalan, John W. Eikelboom, Eliana Vieira Santucci, Derek R. Townsend, Raúl Gonzalez, Tomas VanHelder, Sean McMurtry, Susana Díaz, Catherine Royer, Hussein Cassimjee, James D. Douketis, Ahsun Khan, V Vasanthan, Chew Yin Wang, Sadeesh Srinathan, A. Wahab Undok, Deven Reddy, Paola Muti, Paul Jackson, Javier Ganame, Danielle MacNeil, Pilar Paniagua, Graham S. Hillis, Wojciech Szczeklik, Azim S. Gangji, Stephen D. Walter, Andrew Worster, Matthew B. McQueen, Sadeesh K Srinathan, Otavio Berwanger, Cameron Egan, Aine Mugabi, Neil MacDonald, Erica Aranha Suzumura, Matthew J. McQueen, Reitze N. Rodseth, Maria Del Barrio, Peter A. Kavsak, Cristina Ibanez Esteve, David Szalay, Olga L. Cortés, Fidel Reyes, John Whittle, Gracie Ong, Troy S. Wildes, Ngan N. Lam, Karen Raymer, C. Williams, G.L. Ackland, Enrico Vizza, Salim Yusuf, Wan Azman Ahmad, Radhika Dhanpal, Barbara Sokołowska, David Cain, Andre Lamy, Alexandre Biasi Cavalcanti, Marko Mrkobrada, James Hankinson, Emmanuelle Duceppe, Julian Scott, Maria Tiboni, Tomasz Mrowiecki, Vanessa Valderrama-Victoria, Paweł Iwaszczuk, Robert Sapsford, Andrew Wragg, Atiya Faruqui, Edyta Niebrzegowska, Mohit Bhandari, Teresa Del Castillo, Jean Pierre Goarin, Marko Simunovic, Omid Salehian, Smitha Almeida, Ingeborg Welters, Lehana Thabane, D.L. Skinner, Tej Sheth, Alvin S.B. Tan, Ignacio Garutti, Daniel I. Sessler, Sabu Thomas, Sarah D. McDonald, Trevor W R Lee, Marzida Mansor, Julian H. Barth, Nikki Dewhirst, Xavier Pelaez, Valsa Abraham, Jill Rudkowski, Sanjit S. Jolly, Azad Hassan Abdul Razack, Marcin Raczek, Duane J. Funk, Deborah J. Cook, Martin O'Donnell, and Denis Xavier
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medicine.medical_specialty ,biology ,Troponin T ,business.industry ,Hazard ratio ,Infarction ,Perioperative ,medicine.disease ,Troponin ,Surgery ,Anesthesiology and Pain Medicine ,Internal medicine ,medicine ,biology.protein ,Cardiology ,Myocardial infarction ,Prospective cohort study ,business ,Cohort study - Abstract
Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study’s four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS. Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated “abnormal” laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria. Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors’ diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96–5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6–41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom. Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.
- Published
- 2014
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