Incidence and hospital mortality of vascular surgery patients with perioperative myocardial infarction (PMI) or myocardial injury after non-cardiac surgery (MINS)

Kisten, T; Biccard, Bruce

doi:10.1080/22201181.2017.1317992

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…Furthermore, the definition of MI is adapted from previous studies, using available ICD9 coding and does not reflect the changes in sensitivity and threshold of troponin I enzyme for clinical detection of MI. 34 The temporal relationship between the occurrence of MI or CAR and the index operation is unknown. To decrease the impact of preoperative events, we only included patients with elective admissions for analysis.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Myocardial Infarction After High-Risk Vascular Operations in Adults

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Incidence of Myocardial Infarction After High-Risk Vascular Operations in Adults

et al. 2017

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“…Elevated postoperative cTns are independently prognostic for mortality and MACE. High certainty evidence supports its measurement to aid prognosis of 30-day all-cause mortality 30–42 . Moderate certainty evidence supports the measurement of postoperative cardiac troponins to aid prognosis of 1-year mortality 8,24,33,40,42,45–53 .…”

Section: Clinical Practice Statements Regarding Postoperative Cardiac...mentioning

confidence: 95%

“…Large, observational studies have demonstrated increased cardiac troponin (cTn) levels as prognostic factors in non-cardiac surgery patients. These studies have established an association between increased cTn and cardiovascular and non-cardiovascular complications, poor short- and long-term cardiovascular outcomes and mortality 3–58 . The contribution of cTn to improved/incremental prediction is less well explored 3,10,15,16,18,24,26–32,40–44,55,58 .…”

Section: Introductionmentioning

confidence: 99%

ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation

Lurati Buse,

Bollen Pinto,

Abelha

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND In recent years, there has been increasing focus on the use of cardiac biomarkers in patients undergoing noncardiac surgery. AIMS The aim of this focused guideline was to provide updated guidance regarding the pre-, post- and combined pre-and postoperative use of cardiac troponin and B-type natriuretic peptides in adult patients undergoing noncardiac surgery. METHODS The guidelines were prepared using Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. This included the definition of critical outcomes, a systematic literature search, appraisal of certainty of evidence, evaluation of biomarker measurement in terms of the balance of desirable and undesirable effects including clinical outcomes, resource use, health inequality, stakeholder acceptance, and implementation. The panel differentiated between three different scopes of applications: cardiac biomarkers as prognostic factors, as tools for risk prediction, and for biomarker-enhanced management strategies. RESULTS In a modified Delphi process, the task force defined 12 critical outcomes. The systematic literature search resulted in over 25,000 hits, of which 115 full-text articles formed the body of evidence for recommendations. The evidence appraisal indicated heterogeneity in the certainty of evidence across critical outcomes. Further, there was relevant gradient in the certainty of evidence across the three scopes of application. Recommendations were issued and if this was not possible due to limited evidence, clinical practice statements were produced. CONCLUSION The ESAIC focused guidelines provide guidance on the perioperative use of cardiac troponin and B-type natriuretic peptides in patients undergoing noncardiac surgery, for three different scopes of application.

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“…With regard to surgical specialties, vascular surgery was associated with a mortality rate of 0.02 (95 per cent c.i. 0.01–0.05) per day 28 , 39 , 41 , 42 , 45 , 57 , whilst the mortality rate for orthopaedic patients was 0.06 (95 per cent c.i. 0.02–0.21) per day 29 , 31 , 55 , 59 , 64 ( Fig.…”

Section: Resultsmentioning

confidence: 97%

“…The majority of studies included all types of non-cardiac surgery in their eligibility criteria 2 , 15 , 22 , 30 , 33–35 , 37 , 38 , 40 , 43 , 44 , 46–49 , 51 , 56 , 58 , 60–62 , 65 . Seventeen studies focused on specific surgical subspecialties including vascular 28 , 39 , 41 , 42 , 45 , 52–54 , orthopaedic 29 , 31 , 32 , 50 , 55 , 59 , 64 , urology 36 , 63 and thoracic surgery 36 , 63 . Regarding surgical acuity, only two studies focused on emergency non-cardiac surgery 31 , 32 , whilst nine studies specifically included only patients undergoing elective surgery 28 , 35–38 , 52 , 53 , 58 , 63 .…”

Section: Resultsmentioning

confidence: 99%

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

et al. 2023

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Background Myocardial injury after non-cardiac surgery is diagnosed following asymptomatic troponin elevation in the perioperative interval. Myocardial injury after non-cardiac surgery is associated with high mortality rates and significant rates of major adverse cardiac events within the first 30 days following surgery. However, less is known regarding its impact on mortality and morbidity beyond this time. This systematic review and meta-analysis aimed to establish the rates of long-term morbidity and mortality associated with myocardial injury after non-cardiac surgery. Methods MEDLINE, Embase and Cochrane CENTRAL were searched, and abstracts screened by two reviewers. Observational studies and control arms of trials, reporting mortality and cardiovascular outcomes beyond 30 days in adult patients diagnosed with myocardial injury after non-cardiac surgery, were included. Risk of bias was assessed using the Quality in Prognostic Studies tool. A random-effects model was used for the meta-analysis of outcome subgroups. Results Searches identified 40 studies. The meta-analysis of 37 cohort studies found a rate of major adverse cardiac events-associated myocardial injury after non-cardiac surgery of 21 per cent and mortality following myocardial injury after non-cardiac surgery was 25 per cent at 1-year follow-up. A non-linear increase in mortality rate was observed up to 1 year after surgery. Major adverse cardiac event rates were also lower in elective surgery compared with a subgroup including emergency cases. The analysis demonstrated a wide variety of accepted myocardial injury after non-cardiac surgery and major adverse cardiac events diagnostic criteria within the included studies. Conclusion A diagnosis of myocardial injury after non-cardiac surgery is associated with high rates of poor cardiovascular outcomes up to 1 year after surgery. Work is needed to standardize diagnostic criteria and reporting of myocardial injury after non-cardiac surgery-related outcomes. Registration This review was prospectively registered with PROSPERO in October 2021 (CRD42021283995).

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Incidence and hospital mortality of vascular surgery patients with perioperative myocardial infarction (PMI) or myocardial injury after non-cardiac surgery (MINS)

Cited by 8 publications

References 16 publications

Incidence of Myocardial Infarction After High-Risk Vascular Operations in Adults

Incidence of Myocardial Infarction After High-Risk Vascular Operations in Adults

ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

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