Perioperative myocardial cell injury: The relationship between troponin t and cortisol

Mahla, Elisabeth; Tiesenhausen, Kurt; Rehak, Peter; Fruhwald, Sonja; Pürstner, P.; Metzler, H.

doi:10.1016/s0952-8180(00)00150-1

Cited by 19 publications

(19 citation statements)

References 42 publications

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“…1 illustrates how these factors initiate inflammatory, hypercoagulable, stress and hypoxic states, which are associated with perioperative elevations in troponin levels, arterial thrombosis and mortality. [30][31][32][33][34][35] Increasing grades of surgical trauma and general anesthesia can initiate inflammatory and hypercoagulable states. 31,[36][37][38][39] The inflammatory state involves increases in tumour necrosis factor-α, interleukin (IL)-1, IL-6 and Creactive protein; these factors may have a direct role in initiating plaque fissuring and acute coronary thrombosis.…”

Section: Triggers Of Perioperative Myocardial Infarctionmentioning

confidence: 99%

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Devereaux

Goldman

Cook

et al. 2005

CMAJ

581

350

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THIS IS THE FIRST OF 2 ARTICLES EVALUATING cardiac events in patients undergoing noncardiac surgery. In this article, we review the magnitude of the problem, the pathophysiology of these events, approaches to risk assessment and communication of risk. The number of patients undergoing noncardiac surgery worldwide is growing, and annually 500 000 to 900 000 of these patients experience perioperative cardiac death, nonfatal myocardial infarction (MI) or nonfatal cardiac arrest. Although the evidence is limited, a substantial proportion of fatal perioperative MIs may not share the same pathophysiology as nonoperative MIs. A clearer understanding of the pathophysiology is needed to direct future research evaluating prophylactic, acute and long-term interventions. Researchers have developed tools to facilitate the estimation of perioperative cardiac risk. Studies suggest that the Lee index is the most accurate generic perioperative cardiac risk index. The limitations of the studies evaluating the ability of noninvasive cardiac tests to predict perioperative cardiac risk reveals considerable uncertainty as to the role of these popular tests. Similarly, there is uncertainty as to the predictive accuracy of the American College of Cardiology / American Heart Association algorithm for cardiac risk assessment. Patients are likely to benefit from improved estimation and communication of cardiac risk because the majority of noncardiac surgeries are elective and accurate risk estimation is important to allow informed patient and physician decision-making

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Section: Triggers Of Perioperative Myocardial Infarctionmentioning

confidence: 99%

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Devereaux

Goldman

Cook

et al. 2005

CMAJ

581

350

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“…It is believed that an imbalance between oxygen supply and demand could be a major cause of myocardial ischaemia and infarction in patients with stable CAD undergoing non-cardiac surgery 13 . Surgical stress with pain, hypothermia, and anaemia results in catecholamine/cortisol release and an increase in heart rate and oxygen demand 26,27 ; at the same time, perioperative hypotension, hypoxaemia, and anaemia decrease the oxygen supply to the myocardium. This mismatch between oxygen supply and demand results in myocardial ischaemia and infarction, Figure 1.…”

Section: Pathophysiology Of Perioperative Myocardial Ischaemia and Infamentioning

confidence: 99%

“…Studies on the incidence of perioperative myocardial damage and its influence on cardiac complications and outcome in patients undergoing non-cardiac surgery are presented in Table 5 7, 13,14,27,53,75,76,80,[106][107][108][109][110][111][112][113][114][115][116][117][118] . These studies all show that myocardial damage, defined as a troponin elevation, is significantly correlated to adverse perioperative outcome.…”

Section: Perioperative Myocardial Damage and Outcomementioning

confidence: 99%

“…159 (29) 121 (65) 50 (72) 134 (61) Calcium channel blockers 65 (12) 37 (20) 17 (25) 59 (27) ACE inhibitors 89 (16) 86 (46) 30 (43) 92 (42) Diuretics 157 (29) 119 (64) 47 (68) 83 (38) Organic Nitrates 67 (12) 56 (30) 25 (36) 40 (18) Aspirin 77 (14) 91 (49) 41 (59) 197 (90) Insulin 25 (5) 42 (23) 4 (6) 49 (22) Statins NA 63 (34) 21 (30) 125 (57) T y p e o f s u r Abdominal 181 (33) 58 (31) 52 (24) Urology 150 (27) 3 (2) 61 (28) Orthopaedics 131 (24) 112 (60) 69 (100) 96 ( (47) 91 (49) 4 (6) 49 (22) Regional 231(42) l 95 (51) 65 (94) 108 (49) 8 ( …”

Section: Medication: Betablockersmentioning

confidence: 99%

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Perioperative myocardial damage and cardiac outcome in patients‐at‐risk undergoing non‐cardiac surgery

Tibblin¹

2010

Acta Anaesthesiol Scand

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Despite increasingly sophisticated perioperative management, cardiovascular complications continue to be major challenges for the clinician. As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing noncardiac surgery, cardiovascular complications will remain a significant clinical problem in the future. The overall objective of this thesis was to study the incidence of myocardial damage and perioperative adverse cardiac events, to determine predictors of poor outcome and to assess the effect of a medical intervention in patients at risk undergoing non-cardiac surgery. The studies in this thesis were conducted on a total of 952 patients undergoing non-cardiac surgery. Studies I and IV were multicenter studies; whereas the patients included in studies II and III underwent non-cardiac surgery at Linkoping University Hospital, Sweden. The correlation between postoperative myocardial damage and short-and long-term outcome were studied in 546 patients, aged 70 years or older undergoing non-cardiac surgery of at least 30 minutes duration. This study showed a close correlation between postoperative myocardial damage and poor short-as well as long-term outcome. Elevated Troponin T was a strong independent predictor of mortality within one year of surgery. In 186 patients with ASA physical status classification III or IV undergoing non-elective surgery, the incidence of myocardial damage was 33%. In this study preoperative myocardial damage was an independent predictor of major adverse cardiac events in the postoperative period. In 69 patients with ASA physical status classification III & IV undergoing acute hip surgery, we found a close correlation between elevated NT-proBNP value prior to surgery and cardiac complications in the postoperative period. To study the effect of acetylsalicylic acid on postoperative myocardial damage and cardiovascular events, 220 patients at risk were randomized to receive 75 mg of acetylsalicylic acid or placebo 7 days prior to surgery until the third postoperative day. This study showed that treatment with acetylsalicylic acid resulted in an 8% (95% CI 1-15%) absolute risk reduction of having a postoperative major adverse cardiac event. No statistically significant differences of bleeding complications were seen between the groups. In conclusion, this thesis contributes to the understanding of the clinical relevance of elevated cardiac markers (with or without clinical or ECG signs of myocardial damage) in patients undergoing elective or emergency surgery. Moreover, we have identified predictors of poor outcome in the perioperative period that could be used as tools for identifying patients at risk. Finally, we have shown that continuing acetylsalicylic acid in the perioperative period reduced the risk of major adverse cardiac events within 30 days of surgery.

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“…Surgery is the ultimate cardiovascular stress test, due to several factors such as surgical trauma, anesthesia and analgesia, intubation and extubation, pain, hypothermia, bleeding, anemia, and fasting [12][13][14][15] . These factors can initiate inflammatory, hypercoagulable, stress and hypoxic states, which are associated with perioperative elevations in troponin levels and arterial thrombosis, finally resulting in myocardial infarction (MI) and mortality [16][17][18][19] . These multiple triggers and states open the possibility for a variety of potential prophylactic interventions, such as beta-blockers, acetylsalicylic acid (ASA), calcium-channel blockers, alpha-adrenergic blockers, alphaadrenergic agonists, and statins 2,20-23 .…”

Section: What Interventions To Test?mentioning

confidence: 99%

Ensaios clínicos aleatórios de larga escala em medicina cardiovascular perioperatória: uma proposta para delineamento, condução e gerenciamento eficiente

Berwanger

Suzumura

Devereaux

2009

Arq. Bras. Cardiol.

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The number of patients undergoing noncardiac surgery is growing worldwide. To optimally assist patients during the perioperative period, we must improve our knowledge of how to prevent major perioperative cardiovascular events around the time of noncardiac surgery. To achieve this goal there is a need for large randomized controlled trials that can provide reliable and conclusive results in this field. This narrative review describes a proposal for the design, conduct and management of large controlled trials in perioperative cardiovascular medicine.

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Perioperative myocardial cell injury: The relationship between troponin t and cortisol

Cited by 19 publications

References 42 publications

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Perioperative myocardial damage and cardiac outcome in patients‐at‐risk undergoing non‐cardiac surgery

Ensaios clínicos aleatórios de larga escala em medicina cardiovascular perioperatória: uma proposta para delineamento, condução e gerenciamento eficiente

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