Myocardial Injury after Noncardiac Surgery

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

doi:10.1097/aln.0000000000000113

Cited by 786 publications

(240 citation statements)

References 20 publications

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“…An example of surgical stress‐induced organ injury is represented by the occurrence of myocardial injury after non‐cardiac surgery (MINS). MINS is where myocardial injury occurs causing a raised peak troponin T level of > 0.03 ng/ml (even without symptoms or a full definition of myocardial infarction) and it is an independent predictor of 30‐day mortality 17. In a recent large cohort study of over 15,000 patients, 8.0% of patients suffered MINS with around 58% of these patients not fulfilling the universal definition of myocardial infarction and only 15.8% of patients with MINS experienced an ischaemic symptom.…”

Section: Why It Is Important To Control Surgical Stress and Maintainmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

346

198

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BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

show abstract

Section: Why It Is Important To Control Surgical Stress and Maintainmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

346

198

View full text Add to dashboard Cite

show abstract

“…Perioperative myocardial injury detectable by cardiac troponin elevation is estimated to occur in 5% to 25% of the over 200 million patients who undergo noncardiac surgery annually 1, 2, 3, 4. The association between postoperative troponin elevation and short‐term mortality is established 2, 3, 4, 5, 6, 7, 8.…”

Section: Introductionmentioning

confidence: 99%

“…The association between postoperative troponin elevation and short‐term mortality is established 2, 3, 4, 5, 6, 7, 8. However, how this hazard changes over time, and whether it persists long term are not well defined.…”

Section: Introductionmentioning

confidence: 99%

“…Many patients have detectable troponin following noncardiac surgery, but only ≈40% meet the universal definition of Type 1 myocardial infarction (MI) because of an acute coronary syndrome (ACS) 2, 3, 6, 7, 11. It is presumed that most of these events are Type 2 MI, commonly referred to as “demand ischemia,” caused by an imbalance of myocardial oxygen supply in the setting of a fixed coronary artery stenosis and increased demand from perioperative stressors 11.…”

Section: Introductionmentioning

confidence: 99%

“…It is presumed that most of these events are Type 2 MI, commonly referred to as “demand ischemia,” caused by an imbalance of myocardial oxygen supply in the setting of a fixed coronary artery stenosis and increased demand from perioperative stressors 11. The term “myocardial injury after noncardiac surgery” (MINS) has been used by some to describe events in which patients may be asymptomatic, without ECG changes, but still experience low‐grade troponin elevation 3. There exists an unmet need to examine associations between Type 2 MI or baseline troponin elevation and mortality, as there remains a lack of evidence on how to manage patients with perioperative myocardial injury not attributable to ACS 9…”

Section: Introductionmentioning

confidence: 99%

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Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long‐Term Mortality After Noncardiac Vascular Surgery

Reed

Horr

Young

et al. 2017

JAHA

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BackgroundThe 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 ResultsIn 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 26.9 months, there were 2149 (16.7%) deaths. By multivariable Cox proportional hazards analysis, there was a graded increase in mortality with any detectable cTnT compared to <0.01 ng/mL; cTnT 0.01 to 0.029 ng/mL hazard ratio (HR) 1.54 (95% CI 1.18–2.00, P=0.002), 0.03 to 0.099 ng/mL HR 1.86 (95% CI 1.49–2.31, P<0.001), 0.10 to 0.399 ng/mL HR 1.83 (95% CI 1.46–2.31, P<0.001), ≥0.40 ng/mL HR 2.62 (95% CI 2.06–3.32, P<0.001). Mortality for each mechanism of injury was greater than for patients with normal cTnT; baseline cTnT elevation HR 1.71 (95% CI 1.31–2.24; P<0.001), Type 2 myocardial infarction HR 1.88 (95% CI 1.57–2.24; P<0.001), Type 1 MI HR 2.56 (95% CI 2.56, 1.82–3.60; P<0.001). On Kaplan–Meier analysis, long‐term survival did not differ between mechanisms. The hazard of mortality was greatest within the first 10 months postsurgery. Consistent results were obtained in confirmatory propensity‐score matched analyses.ConclusionsAny detectable cTnT ≥0.01 ng/mL is associated with increased long‐term mortality after vascular surgery. This risk is greatest within the first 10 months postoperatively. While short‐term mortality is greatest with Type 1 myocardial infarction, long‐term mortality appears independent of the mechanism of injury.

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Perioperative Management of High-Risk Patients

Aronson

Mythen

2017

JAMA

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Myocardial Injury after Noncardiac Surgery

Abstract: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Cited by 786 publications

References 20 publications

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long‐Term Mortality After Noncardiac Vascular Surgery

Perioperative Management of High-Risk Patients

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