Myocardial Injury after Noncardiac Surgery : a Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

Botto, F.; Alonso-Coello, P.; Chan, M.T.V.; Villar, J.C.; Xavier, D.; Srinathan, S.; Guyatt, G.; Cruz, P.; Graham, M.; Wang, C.Y.; Berwanger, O.; Pearse, R.M.; Biccard, B.M.; Abraham, V.; Malaga, G.; Hillis, G.S.; Rodseth, R.N.; Cook, D.; Polanczyk, C.A.; Szczeklik, W.; Sessler, D.I.; Sheth, T.; Ackland, G.L.; Leuwer, M.; Garg, A.X.; Lemanach, Y.; Pettit, S.; Heels-Ansdell, D.; Luratibuse, G.; Walsh, M.; Sapsford, R.; Schunemann, H.J.; Kurz, A.; Thomas, S.; Mrkobrada, M.; Thabane, L.; Gerstein, H.; Paniagua, P.; Nagele, P.; Raina, P.; Yusuf, S.; Devereaux, P.J.; Mcqueen, M.J.; Bhandari, M.; Bosch, J.; Buckley, N.; Chow, C.K.; Halliwell, R.; Li, S.; Lee, V.W.; Mooney, J.; Furtado, M.V.; Suzumura, E.; Santucci, E.; Leite, K.; Santo, J.A.D.E.; Jardim, C.A.P.; Cavalcanti, A.B.; Guimaraes, H.P.; Jacka, M.J.; Mcalister, F.; Mcmurtry, S.; Townsend, D.; Pannu, N.; Bagshaw, S.; Bessissow, A.; Duceppe, E.; Eikelboom, J.; Ganame, J.; Hankinson, J.; Hill, S.; Jolly, S.; Lamy, A.; Ling, E.; Magloire, P.; Pare, G.; Reddy, D.; Szalay, D.; Tittley, J.; Weitz, J.; Whitlock, R.; Darvish-Kazim, S.; Debeer, J.; Kavsak, P.; Kearon, C.; Mizera, R.; O'Donnell, M.; Pinthus, J.; Ribas, S.; Simunovic, M.; Tandon, V.; Vanhelder, T.; Winemaker, M.; Mcdonald, S.; O'Bryne, P.; Patel, A.; Paul, J.; Punthakee, Z.; Raymer, K.; Salehian, O.; Spencer, F.; Walter, S.; Worster, A.; Adili, A.; Clase, C.; Crowther, M.; Douketis, J.; Gangji, A.; Jackson, P.; Lim, W.; Lovrics, P.; Mazzadi, S.; Orovan, W.; Rudkowski, J.; Soth, M.; Tiboni, M.; Acedillo, R.; Hildebrand, A.; Lam, N.; Macneil, D.; Roshanov, P.S.; Srinathan, S.K.; Ramsey, C.; John, P.S.; Thorlacius, L.; Siddiqui, F.S.; Grocott, H.P.; Mckay, A.; Lee, T.W.R.; Amadeo, R.; Funk, D.; Mcdonald, H.; Zacharias, J.; Cortes, O.L.; Chaparro, M.S.; Vasquez, S.; Castaneda, A.; Ferreira, S.; Coriat, P.; Monneret, D.; Goarin, J.P.; Esteve, C.I.; Royer, C.; Daas, G.; Choi, G.Y.S.; Gin, T.; Lit, L.C.W.; Sigamani, A.; Faruqui, A.; Dhanpal, R.; Almeida, S.; Cherian, J.; Furruqh, S.; Afzal, L.; George, P.; Mala, S.; Muti, P.; Vizza, E.; Wang, C.Y.; Ong, G.S.Y.; Mansor, M.; Tan, A.S.B.; Shariffuddin, I.I.; Vasanthan, V.; Hashim, N.H.M.; Undok, A.W.; Ki, U.; Lai, H.Y.; Ahmad, W.A.; Razack, A.H.A.; Valderrama-Victoria, V.; Loza-Herrera, J.D.; De Los Angeles Lazo, M.; Rotta-Rotta, A.; Sokolowska, B.; Musial, J.; Gorka, J.; Iwaszczuk, P.; Kozka, M.; Chwala, M.; Raczek, M.; Mrowiecki, T.; Kaczmarek, B.; Cassimjee, H.; Gopalan, D.; Kisten, T.; Mugabi, A.; Naidoo, P.; Naidoo, R.; Skinner, D.; Torborg, A.; Urrutia, G.; Maestre, M.L.; Santalo, M.; Gonzalez, R.; Font, A.; Martinez, C.; Pelaez, X.; De Antonio, M.; Villamor, J.M.; Garcia, J.A.; Ferre, M.J.; Popova, E.; Garutti, I.; Fernandez, C.; Palencia, M.; Diaz, S.; Del Castillo, T.; Varela, A.; De Miguel, A.; Munoz, M.; Pineiro, P.; Cusati, G.; Del Barrio, M.; Membrillo, M.J.; Orozco, D.; Reyes, F.; Sapsford, R.J.; Barth, J.; Scott, J.; Hall, A.; Howell, S.; Lobley, M.; Woods, J.; Howard, S.; Fletcher, J.; Dewhirst, N.; Williams, C.; Rushton, A.; Welters, I.; Leuwer, M.; Khan, A.; Niebrzegowska, E.; Benton, S.; Wragg, A.; Archbold, A.; Smith, A.; Mcalees, E.; Ramballi, C.; Macdonald, N.; Januszewska, M.; Stephens, R.; Reyes, A.; Paredes, L.G.; Sultan, P.; Cain, D.; Whittle, J.; Del Arroyo, A.G.; Sun, Z.; Finnegan, P.S.; Egan, C.; Honar, H.; Shahinyan, A.; Panjasawatwong, K.; A. Y., F.; Wang, S.; Reineks, E.; Blood, J.; Kalin, M.; Gibson, D.; Wildes, T.

doi:10.1097/ALN.0000000000000113

BACKGROUND:: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS. METHODS:: In this international, prospective cohort study of 15, 065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated "abnormal" laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria. RESULTS:: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors' diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96-5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6-41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom. CONCLUSION:: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Myocardial Injury after Noncardiac Surgery : a Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes / F. Botto, P. Alonso-Coello, M.T.V. Chan, J.C. Villar, D. Xavier, S. Srinathan, G. Guyatt, P. Cruz, M. Graham, C.Y. Wang, O. Berwanger, R.M. Pearse, B.M. Biccard, V. Abraham, G. Malaga, G.S. Hillis, R.N. Rodseth, D. Cook, C.A. Polanczyk, W. Szczeklik, D.I. Sessler, T. Sheth, G.L. Ackland, M. Leuwer, A.X. Garg, Y. Lemanach, S. Pettit, D. Heels-Ansdell, G. Luratibuse, M. Walsh, R. Sapsford, H.J. Schunemann, A. Kurz, S. Thomas, M. Mrkobrada, L. Thabane, H. Gerstein, P. Paniagua, P. Nagele, P. Raina, S. Yusuf, P.J. Devereaux, M.J. Mcqueen, M. Bhandari, J. Bosch, N. Buckley, C.K. Chow, R. Halliwell, S. Li, V.W. Lee, J. Mooney, M.V. Furtado, E. Suzumura, E. Santucci, K. Leite, J.A.D.E. Santo, C.A.P. Jardim, A.B. Cavalcanti, H.P. Guimaraes, M.J. Jacka, F. Mcalister, S. Mcmurtry, D. Townsend, N. Pannu, S. Bagshaw, A. Bessissow, E. Duceppe, J. Eikelboom, J. Ganame, J. Hankinson, S. Hill, S. Jolly, A. Lamy, E. Ling, P. Magloire, G. Pare, D. Reddy, D. Szalay, J. Tittley, J. Weitz, R. Whitlock, S. Darvish-Kazim, J. Debeer, P. Kavsak, C. Kearon, R. Mizera, M. O'Donnell, J. Pinthus, S. Ribas, M. Simunovic, V. Tandon, T. Vanhelder, M. Winemaker, S. Mcdonald, P. O'Bryne, A. Patel, J. Paul, Z. Punthakee, K. Raymer, O. Salehian, F. Spencer, S. Walter, A. Worster, A. Adili, C. Clase, M. Crowther, J. Douketis, A. Gangji, P. Jackson, W. Lim, P. Lovrics, S. Mazzadi, W. Orovan, J. Rudkowski, M. Soth, M. Tiboni, R. Acedillo, A. Hildebrand, N. Lam, D. Macneil, P.S. Roshanov, S.K. Srinathan, C. Ramsey, P.S. John, L. Thorlacius, F.S. Siddiqui, H.P. Grocott, A. Mckay, T.W.R. Lee, R. Amadeo, D. Funk, H. Mcdonald, J. Zacharias, O.L. Cortes, M.S. Chaparro, S. Vasquez, A. Castaneda, S. Ferreira, P. Coriat, D. Monneret, J.P. Goarin, C.I. Esteve, C. Royer, G. Daas, G.Y.S. Choi, T. Gin, L.C.W. Lit, A. Sigamani, A. Faruqui, R. Dhanpal, S. Almeida, J. Cherian, S. Furruqh, L. Afzal, P. George, S. Mala, P. Muti, E. Vizza, C.Y. Wang, G.S.Y. Ong, M. Mansor, A.S.B. Tan, I.I. Shariffuddin, V. Vasanthan, N.H.M. Hashim, A.W. Undok, U. Ki, H.Y. Lai, W.A. Ahmad, A.H.A. Razack, V. Valderrama-Victoria, J.D. Loza-Herrera, M. De Los Angeles Lazo, A. Rotta-Rotta, B. Sokolowska, J. Musial, J. Gorka, P. Iwaszczuk, M. Kozka, M. Chwala, M. Raczek, T. Mrowiecki, B. Kaczmarek, H. Cassimjee, D. Gopalan, T. Kisten, A. Mugabi, P. Naidoo, R. Naidoo, D. Skinner, A. Torborg, G. Urrutia, M.L. Maestre, M. Santalo, R. Gonzalez, A. Font, C. Martinez, X. Pelaez, M. De Antonio, J.M. Villamor, J.A. Garcia, M.J. Ferre, E. Popova, I. Garutti, C. Fernandez, M. Palencia, S. Diaz, T. Del Castillo, A. Varela, A. De Miguel, M. Munoz, P. Pineiro, G. Cusati, M. Del Barrio, M.J. Membrillo, D. Orozco, F. Reyes, R.J. Sapsford, J. Barth, J. Scott, A. Hall, S. Howell, M. Lobley, J. Woods, S. Howard, J. Fletcher, N. Dewhirst, C. Williams, A. Rushton, I. Welters, M. Leuwer, A. Khan, E. Niebrzegowska, S. Benton, A. Wragg, A. Archbold, A. Smith, E. Mcalees, C. Ramballi, N. Macdonald, M. Januszewska, R. Stephens, A. Reyes, L.G. Paredes, P. Sultan, D. Cain, J. Whittle, A.G. Del Arroyo, Z. Sun, P.S. Finnegan, C. Egan, H. Honar, A. Shahinyan, K. Panjasawatwong, A.Y. Fu, S. Wang, E. Reineks, J. Blood, M. Kalin, D. Gibson, T. Wildes. - In: ANESTHESIOLOGY. - ISSN 0003-3022. - 120:3(2014), pp. 564-578. [10.1097/ALN.0000000000000113]

Myocardial Injury after Noncardiac Surgery : a Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

Botto F.;Alonso-Coello P.;Chan M. T. V.;Villar J. C.;Xavier D.;Srinathan S.;Guyatt G.;Cruz P.;Graham M.;Wang C. Y.;Berwanger O.;Pearse R. M.;Biccard B. M.;Abraham V.;Malaga G.;Hillis G. S.;Rodseth R. N.;Cook D.;Polanczyk C. A.;Szczeklik W.;Sessler D. I.;Sheth T.;Ackland G. L.;Leuwer M.;Garg A. X.;Lemanach Y.;Pettit S.;Heels-Ansdell D.;Luratibuse G.;Walsh M.;Sapsford R.;Schunemann H. J.;Kurz A.;Thomas S.;Mrkobrada M.;Thabane L.;Gerstein H.;Paniagua P.;Nagele P.;Raina P.;Yusuf S.;Devereaux P. J.;McQueen M. J.;Bhandari M.;Bosch J.;Buckley N.;Chow C. K.;Halliwell R.;Li S.;Lee V. W.;Mooney J.;Furtado M. V.;Suzumura E.;Santucci E.;Leite K.;Santo J. A. D. E.;Jardim C. A. P.;Cavalcanti A. B.;Guimaraes H. P.;Jacka M. J.;McAlister F.;McMurtry S.;Townsend D.;Pannu N.;Bagshaw S.;Bessissow A.;Duceppe E.;Eikelboom J.;Ganame J.;Hankinson J.;Hill S.;Jolly S.;Lamy A.;Ling E.;Magloire P.;Pare G.;Reddy D.;Szalay D.;Tittley J.;Weitz J.;Whitlock R.;Darvish-Kazim S.;Debeer J.;Kavsak P.;Kearon C.;Mizera R.;O'Donnell M.;Pinthus J.;Ribas S.;Simunovic M.;Tandon V.;Vanhelder T.;Winemaker M.;McDonald S.;O'Bryne P.;Patel A.;Paul J.;Punthakee Z.;Raymer K.;Salehian O.;Spencer F.;Walter S.;Worster A.;Adili A.;Clase C.;Crowther M.;Douketis J.;Gangji A.;Jackson P.;Lim W.;Lovrics P.;Mazzadi S.;Orovan W.;Rudkowski J.;Soth M.;Tiboni M.;Acedillo R.;Hildebrand A.;Lam N.;MacNeil D.;Roshanov P. S.;Srinathan S. K.;Ramsey C.;John P. S.;Thorlacius L.;Siddiqui F. S.;Grocott H. P.;McKay A.;Lee T. W. R.;Amadeo R.;Funk D.;McDonald H.;Zacharias J.;Cortes O. L.;Chaparro M. S.;Vasquez S.;Castaneda A.;Ferreira S.;Coriat P.;Monneret D.;Goarin J. P.;Esteve C. I.;Royer C.;Daas G.;Choi G. Y. S.;Gin T.;Lit L. C. W.;Sigamani A.;Faruqui A.;Dhanpal R.;Almeida S.;Cherian J.;Furruqh S.;Afzal L.;George P.;Mala S.;P. Muti^{Investigation};Vizza E.;Wang C. Y.;Ong G. S. Y.;Mansor M.;Tan A. S. B.;Shariffuddin I. I.;Vasanthan V.;Hashim N. H. M.;Undok A. W.;Ki U.;Lai H. Y.;Ahmad W. A.;Razack A. H. A.;Valderrama-Victoria V.;Loza-Herrera J. D.;De Los Angeles Lazo M.;Rotta-Rotta A.;Sokolowska B.;Musial J.;Gorka J.;Iwaszczuk P.;Kozka M.;Chwala M.;Raczek M.;Mrowiecki T.;Kaczmarek B.;Cassimjee H.;Gopalan D.;Kisten T.;Mugabi A.;Naidoo P.;Naidoo R.;Skinner D.;Torborg A.;Urrutia G.;Maestre M. L.;Santalo M.;Gonzalez R.;Font A.;Martinez C.;Pelaez X.;De Antonio M.;Villamor J. M.;Garcia J. A.;Ferre M. J.;Popova E.;Garutti I.;Fernandez C.;Palencia M.;Diaz S.;Del Castillo T.;Varela A.;De Miguel A.;Munoz M.;Pineiro P.;Cusati G.;Del Barrio M.;Membrillo M. J.;Orozco D.;Reyes F.;Sapsford R. J.;Barth J.;Scott J.;Hall A.;Howell S.;Lobley M.;Woods J.;Howard S.;Fletcher J.;Dewhirst N.;Williams C.;Rushton A.;Welters I.;Leuwer M.;Khan A.;Niebrzegowska E.;Benton S.;Wragg A.;Archbold A.;Smith A.;McAlees E.;Ramballi C.;MacDonald N.;Januszewska M.;Stephens R.;Reyes A.;Paredes L. G.;Sultan P.;Cain D.;Whittle J.;Del Arroyo A. G.;Sun Z.;Finnegan P. S.;Egan C.;Honar H.;Shahinyan A.;Panjasawatwong K.;Fu A. Y.;Wang S.;Reineks E.;Blood J.;Kalin M.;Gibson D.;Wildes T.

2014

Abstract

BACKGROUND:: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS. METHODS:: In this international, prospective cohort study of 15, 065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated "abnormal" laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria. RESULTS:: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors' diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96-5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6-41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom. CONCLUSION:: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Scheda breve

Scheda completa

Scheda completa (DC)

	Parole chiave
	
			Age Distribution; Aged; Cohort Studies; Humans; Male; Middle Aged; Myocardial Ischemia; Postoperative Complications; Prognosis; Prospective Studies; Troponin T; Patient Outcome Assessment; Surgical Procedures, Operative
		
	Settori scientifico-disciplinari dell'articolo
	
			Settore MED/01 - Statistica Medica
		
	Data di pubblicazione
	
			2014
		
	Rivista in ANCE
	
			ANESTHESIOLOGY
		
	DOI
	
			https://dx.doi.org/10.1097/ALN.0000000000000113
		
	Tipologia
	
			Article (author)
		
	Appare nelle tipologie:
	
			01 - Articolo su periodico

File in questo prodotto:

File	Dimensione	Formato
MINS paper Nov 7, 2013 pjd.pdf accesso aperto Tipologia: Pre-print (manoscritto inviato all'editore) Dimensione 253.38 kB Formato Adobe PDF Visualizza/Apri	253.38 kB	Adobe PDF	Visualizza/Apri
20140300.0-00017.pdf accesso riservato Tipologia: Publisher's version/PDF Dimensione 462.74 kB Formato Adobe PDF Visualizza/Apri Richiedi una copia	462.74 kB	Adobe PDF	Visualizza/Apri Richiedi una copia

Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/662644

Citazioni

190

736

627

IRIS Institutional Research Information System - AIR Archivio Istituzionale della Ricerca