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Myocardial Injury after Noncardiac Surgery

2014; Lippincott Williams & Wilkins; Volume: 120; Issue: 3 Linguagem: Inglês

10.1097/aln.0000000000000113

1528-1175

Fernando Botto, Pablo Alonso‐Coello, Matthew T.V. Chan, Juan Carlos Villar, Denis Xavier, Sadeesh Srinathan, Gordon Guyatt, Patrícia Cruz, Michelle M. Graham, C. Y. Wang, Otávio Berwanger, Rupert M Pearse, Bruce Biccard, Valsa Abraham, Germán Málaga, Graham S. Hillis, Reitze Rodseth, Deborah J. Cook, Carísi Anne Polanczyk, Wojciech Szczeklik, Daniel I. Sessler, Tej Sheth, Gareth L. Ackland, M. Leuwer, Amit X. Garg, Yannick LeManach, Shirley Pettit, Diane Heels‐Ansdell, Giovanna Lurati Buse, Michael Walsh, Robert J. Sapsford, Holger J. Schünemann, Andrea Kurz, Sabu Thomas, Marko Mrkobrada, Lehana Thabane, Hertzel C. Gerstein, Pilar Paniagua, Peter Nägele, Parminder Raina, Salim Yusuf, P.J. Devereaux, Matthew J McQueen, Mohit Bhandari, Jackie Bosch, Norman Buckley, Clara K Chow, Richard Halliwell, Stephen Li, Vincent Lee, John Mooney, Mariana V Furtado, Érica Aranha Suzumura, Eliana Vieira Santucci, Kátia Ramos Moreira Leite, Jose Amalth do Espirirto Santo, Cesar A P Jardim, Alexandre Biasi Cavalcanti, Hélio Penna Guimarães, Michael J. Jacka, Finlay A. McAlister, Sean McMurtry, Derek R. Townsend, Neesh Pannu, Sean M. Bagshaw, Amal Bessissow, Emmanuelle Duceppe, John W. Eikelboom, Javier Gáname, James Hankinson, Stephen Hill, Sanjit S. Jolly, André Lamy, Elizabeth Ling, Patrick Magloire, Guillaume Paré, Deven Reddy, David Szalay, Jacques G. Tittley, Jeff Weitz, Richard Whitlock, Saeed Darvish-Kazim, Justin DeBeer, Peter A. Kavsak, Clive Kearon, Richard Mizera, Martin O’Donnell, Matthew McQueen, Jehonathan H. Pinthus, Sebastián Ribas, Marko Šimunović, Vikas Tandon, Tomas Vanhelder, Mitchell Winemaker, Sarah McDonald, Paul M. O'Bryne, Ameen Patel, James Paul, Zubin Punthakee, Karen Raymer, Omid Salehian, Fred Spencer, Stephen D. Walter, Andrew Worster, Anthony Adili, Catherine M. Clase, Mark Crowther, James Douketis, Azim S. Gangji, Paul Jackson, Wendy Lim, Peter Lovrics, S Mazzadi, William Orovan, Jill Rudkowski, Mark Soth, Maria Tiboni, Rey Acedillo, Amit X. Garg, Ainslie Hildebrand, Ngan N. Lam, Danielle MacNeil, Pavel S Roshanov, Sadeesh Srinathan, Clare D. Ramsey, Philip St. John, Laurel Thorlacius, Faisal Sharaf Siddiqui, Hilary P. Grocott, Andrew McKay, Trevor W R Lee, Ryan Amadeo, Duane J. Funk, Heather McDonald, James Zacharias, Olga Cortés, Maria Stella Chaparro, Skarlett Vásquez, Alvaro Castañeda, Silvia Moreira Ayub‐Ferreira, Pierre Coriat, Denis Monneret, Jean Pierre Goarin, Cristina Ibáñez, Catherine A. Royer, G Daas, Gordon Choi, Tony Gin, Lydia C.W. Lit, Alben Sigamani, Atiya Faruqui, Radhika Dhanpal, Smitha Almeida, J Cherian, Sultana Furruqh, Lalita Afzal, Preetha George, Shaveta Mala, Holger Schünemann, Paola Muti, Enrico Vizza, G S Y Ong, Marzida Mansor, Alvin Tan, Ina Ismiarti Shariffuddin, Vishnu Vasanthan, N. H. M. Hashim, A Wahab Undok, Ushananthini Ki, Hou Yee Lai, Wan Azman Ahmad, Azad Hassan Abdul Razack, Vanessa Valderrama-Victoria, Javier D Loza-Herrera, Maria Lazo, Aida Rotta-Rotta, Barbara Sokolowska, Jacek Musiał, Jacek Górka, Paweł Iwaszczuk, Mateusz Kózka, Maciej Chwała, Marcin Raczek, Tomasz Mrowiecki, Bogusz Kaczmarek, Bruce Biccard, Hussein Cassimjee, Dean Gopalan, Theroshnie Kisten, Aine Mugabi, Prebashini Naidoo, Rubeshan Naidoo, Reitze Rodseth, David Lee Skinner, Alex Torborg, Gerard Urrútia, M. Luz Maestre, Miquel Santaló, Raúl González, A.E González Font, Cecilia Martínez, Xavier Peláez, Marta de Antonio, Jose Marcial Villamor, Jesús Álvarez‐García, Maria José Ferré, Ekaterine Popova, Ignacio Garutti, Carmen Fernández, M. Palencia, Susana Valencia Díaz, Teresa Del Castillo, A. Quiroga Varela, Angeles de Miguel, Manuel Múñoz, Patricia Piñeiro, Gabriel Cusati, M Barrio, Maria José Membrillo, David Orozco, Fidel Reyes, Robert J Sapsford, Julian H. Barth, J. Hebbring Scott, Alistair S. Hall, Simon Howell, Michaela Lobley, Janet Woods, Susannah Howard, Joanne Fletcher, Nikki Dewhirst, Colin C. Williams, A. Rushton, Ingeborg Welters, M. Leuwer, Rupert Pearse, Gareth Ackland, Ahsun Khan, Edyta Niebrzegowska, Sally Benton, Andrew Wragg, Andrew Archbold, Amanda Smith, Eleanor McAlees, Cheryl Ramballi, Neil MacDonald, Marta Januszewska, Robert Stephens, Anna Reyes, Laura Gallego Paredes, Pervez Sultan, David Cain, John Whittle, Ana Gutierrez del Arroyo, Zhuo Sun, Patrick Sean Finnegan, Cameron Egan, Hooman Honar, Aram Shahinyan, Krit Panjasawatwong, Alexander Y. Fu, Sihe Wang, Edmunds Reineks, Jane Blood, Megan Kalin, David W. Gibson, Troy S. Wildes, Vascular events In noncardiac Surgery patIents cOhort evaluatioN Investigators,

Aortic aneurysm repair treatments

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.