The emergence of a postoperative myocardial injury epidemic: true or false?

Beattie, W. Scott

doi:10.1007/s12630-021-02027-w

Cited by 6 publications

(3 citation statements)

References 56 publications

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“…Myocardial injury after noncardiac surgery is also defined by elevated cardiac troponin concentrations, but only considers elevations caused by myocardial ischemia and thus requires meticulous outcome adjudication [ 1 , 3 ]. “Acute myocardial injury” and “myocardial injury after noncardiac surgery” may seem to differ only slightly—but represent two different concepts of defining postoperative myocardial injury [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of intraoperative personalized goal-directed hemodynamic management on acute myocardial injury in high-risk patients having major abdominal surgery: a post-hoc secondary analysis of a randomized clinical trial

Kouz

Bergholz

Diener

et al. 2022

J Clin Monit Comput

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Acute myocardial injury is common after noncardiac surgery and associated with mortality. Impaired intraoperative cardiovascular dynamics are a risk factor for acute myocardial injury. Optimizing intraoperative cardiovascular dynamics may thus reduce acute myocardial injury. We aimed to investigate the effect of intraoperative personalized goal-directed hemodynamic management on the incidence of acute myocardial injury. We hypothesized that personalized goal-directed hemodynamic management reduces the incidence of acute myocardial injury compared to routine hemodynamic management in high-risk patients having major abdominal surgery. We performed a post-hoc secondary analysis of a randomized clinical trial including 180 high-risk major abdominal surgery patients that were randomized to personalized goal-directed hemodynamic management or routine hemodynamic management. We compared the incidences of acute myocardial injury—defined according to the Fourth Universal Definition of Myocardial Infarction (2018)—between patients randomized to personalized goal-directed hemodynamic management or routine hemodynamic management by calculating the relative and absolute risk reduction together with 95% Wald confidence intervals and P values. Acute myocardial injury occurred in 4 of 90 patients (4%) in the personalized goal-directed hemodynamic management group and in 12 of 90 patients (13%) in the routine hemodynamic management group (relative risk: 0.33, 95% confidence interval: 0.11 to 0.99, P = 0.036; absolute risk reduction: − 9%, 95% confidence interval: − 17% to − 0.68%, P = 0.034). In this post-hoc secondary analysis, intraoperative personalized goal-directed hemodynamic management reduced the incidence of acute myocardial injury compared to routine hemodynamic management in high-risk patients having major abdominal surgery. This needs to be confirmed in larger prospective trials.

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Section: Discussionmentioning

confidence: 99%

Effect of intraoperative personalized goal-directed hemodynamic management on acute myocardial injury in high-risk patients having major abdominal surgery: a post-hoc secondary analysis of a randomized clinical trial

Kouz

Bergholz

Diener

et al. 2022

J Clin Monit Comput

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“…Three articles shed light into the development, detection, and treatment of three common major postoperative complications [1]-myocardial injury, acute kidney injury, and neurocognitive disorders.There is increasing evidence that perioperative myocardial injury is associated with postoperative mortality and adverse cardiovascular outcomes in patients having noncardiac surgery [3,4]. However, there is an ongoing debate on how to define perioperative myocardial injury and -even more important -how to diagnose, prevent, or treat it [5,6]. Chew and Puelacher (pp.…”

mentioning

confidence: 99%

“…There is increasing evidence that perioperative myocardial injury is associated with postoperative mortality and adverse cardiovascular outcomes in patients having noncardiac surgery [3,4]. However, there is an ongoing debate on how to define perioperative myocardial injury and -even more important -how to diagnose, prevent, or treat it [5,6]. Chew and Puelacher (pp.…”

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confidence: 99%

Editorial: the surgical patient

Flick

Saugel

2021

Current Opinion in Critical Care

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High-risk surgical patients often require monitoring and treatment in ICUs after surgery. The term 'highrisk patient' is vague, but generally describes either patients having major surgery (such as abdominal or cardiac surgery) or patients with substantial comorbidities having any type of surgery. Caring for these patients in the first hours and days after surgery poses numerous challenges to intensivists. This issue of Current Opinion in Critical Care highlights important aspects of postoperative critical care and addresses open research questions that need to be answered to further improve the management of patients after surgery.In high-risk surgical patients, the incidence of postoperative complications remains high [1,2]. Three articles shed light into the development, detection, and treatment of three common major postoperative complications [1]-myocardial injury, acute kidney injury, and neurocognitive disorders.There is increasing evidence that perioperative myocardial injury is associated with postoperative mortality and adverse cardiovascular outcomes in patients having noncardiac surgery [3,4]. However, there is an ongoing debate on how to define perioperative myocardial injury and -even more important -how to diagnose, prevent, or treat it [5,6]. Chew and Puelacher (pp. 670-675) provide a concise summary of different concepts of myocardial injury, namely 'myocardial injury after noncardiac surgery' and 'perioperative myocardial injury'. They also give a comprehensive update on how to diagnose perioperative myocardial injury using routine troponin screening and discuss possible treatment strategies.Just like the heart, the kidneys are sensitive to perioperative organ injury [7]. The incidence of perioperative acute kidney injury is often underestimated as its detection can be challenging. In their review, give an update on the definition of perioperative acute kidney injury -a continuum ranging from normal kidney function to acute and chronic kidney disease. The authors explain recent advancements in diagnostics -especially highlighting functional biomarkers. They further expand on preventive bundles to avoid acute kidney injuryincluding haemodynamic optimization, avoiding nephrotoxins, and glycaemic control.

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