Perioperative myocardial injury in patients receiving cardiac output-guided haemodynamic therapy: a substudy of the OPTIMISE Trial

Gillies, Michael; Shah, Anoop; Mullenheim, J.; Tricklebank, Stephen; Owen, Thomas; Antonelli, Jean; Strachan, Fiona; Mills, Nicholas L; Pearse, Rupert M

doi:10.1093/bja/aev137

Cited by 40 publications

(19 citation statements)

References 42 publications

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“…27 In the metaanalysis, 2193 patients were included. Five of 11 studies were in orthopaedic surgery (n¼993 patients), 12 19 23-25 one study in neurosurgery (n¼100 patients), 14 three studies in abdominal surgery (n¼536 patients), [26][27][28] one study in head and neck cancer surgery (n¼378 patients), 13 and one study in mixed non-cardiac, nonvascular surgery (n¼186 patients). 15 The length of follow-up ranged from 30 days to 8 yr (Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis

Ekeloef

Alamili

Devereaux

et al. 2016

British Journal of Anaesthesia

186

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Section: Study Characteristicsmentioning

confidence: 99%

Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis

Ekeloef

Alamili

Devereaux

et al. 2016

British Journal of Anaesthesia

186

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“… 1 Around 20% of non-cardiac surgical patients sustain perioperative myocardial injury, 2 , 3 which is usually asymptomatic yet strongly associated with hospital readmission 4 and mortality. 5 , 6 , 7 , 8 , 9 Myocardial injury is more common in patients with established cardiovascular risk factors, as estimated using the Revised Cardiac Risk Index (RCRI). 6 , 10 , 11 , 12 However, conventional treatments for myocardial infarction do not reduce myocardial injury, cardiovascular death, or both after non-cardiac surgery.…”

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confidence: 99%

Cardiac vagal dysfunction and myocardial injury after non-cardiac surgery: a planned secondary analysis of the measurement of Exercise Tolerance before surgery study

Abbott

Pearse

Cuthbertson

et al. 2019

British Journal of Anaesthesia

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BackgroundThe aetiology of perioperative myocardial injury is poorly understood and not clearly linked to pre-existing cardiovascular disease. We hypothesised that loss of cardioprotective vagal tone [defined by impaired heart rate recovery ≤12 beats min−1 (HRR ≤12) 1 min after cessation of preoperative cardiopulmonary exercise testing] was associated with perioperative myocardial injury.MethodsWe conducted a pre-defined, secondary analysis of a multi-centre prospective cohort study of preoperative cardiopulmonary exercise testing. Participants were aged ≥40 yr undergoing non-cardiac surgery. The exposure was impaired HRR (HRR≤12). The primary outcome was postoperative myocardial injury, defined by serum troponin concentration within 72 h after surgery. The analysis accounted for established markers of cardiac risk [Revised Cardiac Risk Index (RCRI), N-terminal pro-brain natriuretic peptide (NT pro-BNP)].ResultsA total of 1326 participants were included [mean age (standard deviation), 64 (10) yr], of whom 816 (61.5%) were male. HRR≤12 occurred in 548 patients (41.3%). Myocardial injury was more frequent amongst patients with HRR≤12 [85/548 (15.5%) vs HRR>12: 83/778 (10.7%); odds ratio (OR), 1.50 (1.08–2.08); P=0.016, adjusted for RCRI). HRR declined progressively in patients with increasing numbers of RCRI factors. Patients with ≥3 RCRI factors were more likely to have HRR≤12 [26/36 (72.2%) vs 0 factors: 167/419 (39.9%); OR, 3.92 (1.84–8.34); P<0.001]. NT pro-BNP greater than a standard prognostic threshold (>300 pg ml−1) was more frequent in patients with HRR≤12 [96/529 (18.1%) vs HRR>12 59/745 (7.9%); OR, 2.58 (1.82–3.64); P<0.001].ConclusionsImpaired HRR is associated with an increased risk of perioperative cardiac injury. These data suggest a mechanistic role for cardiac vagal dysfunction in promoting perioperative myocardial injury.

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“…However, some complications will inevitably happen during PCI6. Perioperative myocardial injury (PMI) is one of the common complications to the PCI process, and the incidence rate is approximately 5~30%78. Many research results have indicated that the mechanism of myocardial injury after PCI include vascular endothelial injury, distal microvascular thrombosis, surgical occlusion of the blood vessels, coronary artery spasm, plaque displacement leading to side branch occlusion and reperfusion injury910.…”

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confidence: 99%

The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis

2017

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Many scholars have studied the effect of nicorandil on perioperative myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI), but results are inconsistent. Therefore, we performed this meta-analysis. Finally, 16 articles, including 1616 patients, were included into this meta-analysis. Meta-analysis results showed that: (1) Nicorandil can reduce the level of CK-MB after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (2) Nicorandil can reduce the level of TnT after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (3) Nicorandil can reduce the incidence of adverse reactions after PCI. (4) Nicorandil cannot reduce the level of MVP after PCI, including at 12 hours and 24 hours. (5) Subgroup analysis showed that nicorandil can reduce CK-MB and TnT level at 24 hours after PCI for Chinese’s population (P < 0.05), but can not reduce CK-MB and TnT level at 24 hours after PCI for non Chinese’s population (P > 0.05). Our meta-analysis indicate that nicorandil can reduce myocardial injury and reduce the incidence of adverse reaction caused by PCI for Chinese’s population, but is not obvious for non Chinese’s population. However, this conclusion still needs to be confirmed in the future.

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Perioperative myocardial injury in patients receiving cardiac output-guided haemodynamic therapy: a substudy of the OPTIMISE Trial

Abstract: Myocardial injury is common among patients undergoing major gastrointestinal surgery. In this study, the frequency was not affected by cardiac output-guided fluid and low-dose inotropic therapy.

Cited by 40 publications

References 42 publications

Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis

Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis

Cardiac vagal dysfunction and myocardial injury after non-cardiac surgery: a planned secondary analysis of the measurement of Exercise Tolerance before surgery study

The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis

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