Myocardial Injury after Noncardiac Surgery
Fernando Botto(Chinese University of Hong Kong), Pablo Alonso‐Coello, Matthew T.V. Chan(St. John's University), Juan Carlos Villar(Jagiellonian University), Denis Xavier(McMaster University), Sadeesh Srinathan(University of Manitoba), Gordon Guyatt(McMaster University), Patrícia Cruz(Universidad Complutense de Madrid), Michelle M. Graham(University of Alberta), C. Y. Wang(University of Malaya), Otávio Berwanger(University of Alberta), Rupert M Pearse(Queen Mary University of London), Bruce Biccard(University of KwaZulu-Natal), Valsa Abraham(Christiana Care Health System), Germán Málaga(Jagiellonian University), Graham S. Hillis(The University of Sydney), Reitze Rodseth(University of KwaZulu-Natal), Deborah Cook(Western University), Carísi Anne Polanczyk(Universidade Federal do Rio Grande do Sul), Wojciech Szczeklik(Jagiellonian University), Daniel I. Sessler(Cleveland Clinic), Tej Sheth(McMaster University), Gareth L. Ackland(Washington University in St. Louis), M. Leuwer(University of Liverpool), Amit X. Garg(University of Manitoba), Yannick LeManach(McMaster University), Shirley Pettit(McMaster University), Diane Heels‐Ansdell, Giovanna Lurati Buse(McMaster University), Michael Walsh(McMaster University), Robert J. Sapsford(McMaster University), Holger J. Schünemann(Cleveland Clinic), Andrea Kurz(Washington University in St. Louis), Sabu Thomas(McMaster University), Marko Mrkobrada(Western University), Lehana Thabane, Hertzel C. Gerstein(McMaster University), Pilar Paniagua(Universidad Complutense de Madrid), Peter Nägele(Washington University in St. Louis), Parminder Raina, Salim Yusuf(The University of Sydney), P.J. Devereaux(McMaster University), P.J. Devereaux(McMaster University), Daniel I Sessler(McMaster University), Michael Walsh(McMaster University), Gordon Guyatt, Matthew J McQueen(Universidade Federal do Rio Grande do Sul), Mohit Bhandari(Universidade Federal do Rio Grande do Sul), Deborah Cook(Universidade Federal do Rio Grande do Sul), Jackie Bosch(Universidade Federal do Rio Grande do Sul), Norman Buckley(Universidade Federal do Rio Grande do Sul), Salim Yusuf, Clara K Chow, Graham S. Hillis, Richard Halliwell, Stephen Li, Vincent Lee, John Mooney, Carisi A Polanczyk, Mariana V Furtado, Otavio Berwanger, Érica Aranha Suzumura, Eliana Vieira Santucci, Kátia Ramos Moreira Leite, Jose Amalth do Espirirto Santo, Cesar A P Jardim, Alexandre Biasi Cavalcanti, Hélio Penna Guimarães(McMaster University), Michael J. Jacka(McMaster University), Michelle M. Graham(McMaster University), Finlay A. McAlister(McMaster University), Sean McMurtry(McMaster University), Derek R. Townsend(McMaster University), Neesh Pannu(McMaster University), Sean M. Bagshaw(McMaster University), Amal Bessissow(McMaster University), Mohit Bhandari(McMaster University), Emmanuelle Duceppe(McMaster University), John W. Eikelboom(McMaster University), Javier Gáname(McMaster University), James Hankinson(McMaster University), Stephen Hill(McMaster University), Sanjit S. Jolly(McMaster University), André Lamy(McMaster University), Elizabeth Ling(McMaster University), Patrick Magloire(McMaster University), Guillaume Paré(McMaster University), Deven Reddy(McMaster University), David Szalay(McMaster University), Jacques G. Tittley(McMaster University), Jeff Weitz(McMaster University), Richard Whitlock(McMaster University), Saeed Darvish-Kazim(McMaster University), Justin DeBeer(McMaster University), Peter A. Kavsak(McMaster University), Clive Kearon(McMaster University), Richard Mizera(McMaster University), Martin O’Donnell(McMaster University), Matthew McQueen(McMaster University), Jehonathan H. Pinthus(McMaster University), Sebastián Ribas(McMaster University), Marko Šimunović(McMaster University), Vikas Tandon(Western University), Tomas Vanhelder(McMaster University), Mitchell Winemaker(Western University), Hertzel C. Gerstein(Western University), Sarah McDonald(Western University), Paul M. O'Bryne(Western University), Ameen Patel(Western University), James Paul(Western University), Zubin Punthakee(Western University), Karen Raymer(Western University), Omid Salehian(Western University), Fred Spencer(Western University), Stephen D. Walter(Western University), Andrew Worster(Western University), Anthony Adili(Western University), Catherine M. Clase(University of Manitoba), Deborah Cook(University of Manitoba), Mark Crowther(University of Manitoba), James Douketis(University of Manitoba), Azim S. Gangji(University of Manitoba), Paul Jackson(University of Manitoba), Wendy Lim(Universidad Autónoma de Bucaramanga), Peter Lovrics(Universidad Autónoma de Bucaramanga), S Mazzadi(Universidad Autónoma de Bucaramanga), William Orovan(Universidad Autónoma de Bucaramanga), Jill Rudkowski(Universidad Autónoma de Bucaramanga), Mark Soth(Universidad Autónoma de Bucaramanga), Maria Tiboni(Universidad Autónoma de Bucaramanga), Rey Acedillo(Universidad Autónoma de Bucaramanga), Amit X. Garg(Universidad Autónoma de Bucaramanga), Ainslie Hildebrand(Universidad Autónoma de Bucaramanga), Ngan N. Lam(Universidad Autónoma de Bucaramanga), Danielle MacNeil(Universidad Autónoma de Bucaramanga), Marko Mrkobrada, Pavel S Roshanov, Sadeesh Srinathan, Clare D. Ramsey, Philip St. John, Laurel Thorlacius(Chinese University of Hong Kong), Faisal Sharaf Siddiqui(Chinese University of Hong Kong), Hilary P. Grocott(Chinese University of Hong Kong), Andrew McKay(Chinese University of Hong Kong), Trevor W R Lee(Chinese University of Hong Kong), Ryan Amadeo(Chinese University of Hong Kong), Duane J. Funk, Heather McDonald, James Zacharias, Juan Carlos Villar(Christian Medical College, Vellore), Olga Cortés(Christian Medical College, Vellore), Maria Stella Chaparro(Christian Medical College, Vellore), Skarlett Vásquez(Christian Medical College, Vellore), Alvaro Castañeda(Christian Medical College, Vellore), Silvia Moreira Ayub‐Ferreira(Christian Medical College, Vellore), Pierre Coriat, Denis Monneret, Jean Pierre Goarin, Cristina Ibanez Esteve(Cleveland Clinic), Catherine A. Royer(University of Malaya), G Daas(University of Malaya), Matthew T V Chan(Universidad Peruana Cayetano Heredia), Gordon Choi(Universidad Peruana Cayetano Heredia), Tony Gin(Universidad Peruana Cayetano Heredia), Lydia C.W. Lit(Universidad Peruana Cayetano Heredia), Denis Xavier(Universidad Peruana Cayetano Heredia), Alben Sigamani(Universidad Peruana Cayetano Heredia), Atiya Faruqui(Universidad Peruana Cayetano Heredia), Radhika Dhanpal(Universidad Peruana Cayetano Heredia), Smitha Almeida(Universidad Peruana Cayetano Heredia), J Cherian(Universidad Peruana Cayetano Heredia), Sultana Furruqh(Universidad Peruana Cayetano Heredia), Valsa Abraham(Jagiellonian University), Lalita Afzal(Jagiellonian University), Preetha George(Jagiellonian University), Shaveta Mala(Jagiellonian University), Holger Schünemann(University of KwaZulu-Natal), Paola Muti(University of KwaZulu-Natal), Enrico Vizza(University of KwaZulu-Natal), C. Y. Wang(University of KwaZulu-Natal), G S Y Ong(University of KwaZulu-Natal), Marzida Mansor(University of KwaZulu-Natal), Alvin Tan(University of KwaZulu-Natal), Ina Ismiarti Shariffuddin(University of KwaZulu-Natal), Vishnu Vasanthan(University of KwaZulu-Natal), N. H. M. Hashim(University of KwaZulu-Natal), A Wahab Undok, Ushananthini Ki, Hou Yee Lai, Wan Azman Ahmad, Azad Hassan Abdul Razack, German Malaga, Vanessa Valderrama-Victoria(University of KwaZulu-Natal), Javier D Loza-Herrera, Maria Lazo, Aida Rotta-Rotta(Universidad Complutense de Madrid), Wojciech Szczeklik(Universidad Complutense de Madrid), Barbara Sokolowska(Universidad Complutense de Madrid), Jacek Musiał(Universidad Complutense de Madrid), Jacek Górka(Universidad Complutense de Madrid), Paweł Iwaszczuk(Universidad Complutense de Madrid), Mateusz Kózka(Universidad Complutense de Madrid), Maciej Chwała(Universidad Complutense de Madrid), Marcin Raczek(Universidad Complutense de Madrid), Tomasz Mrowiecki(Universidad Complutense de Madrid), Bogusz Kaczmarek(Universidad Complutense de Madrid), Bruce Biccard(Universidad Complutense de Madrid), Hussein Cassimjee, Dean Gopalan, Theroshnie Kisten, Aine Mugabi, Prebashini Naidoo, Rubeshan Naidoo, Reitze Rodseth, David Lee Skinner, Alex Torborg, Pilar Paniagua, Gerard Urrútia, M. Luz Maestre, Miquel Santaló, Raúl González, A.E González Font(University of Liverpool), Cecilia Martínez(University of Liverpool), Xavier Peláez(University of Liverpool), Marta de Antonio(University of Liverpool), Jose Marcial Villamor(University of Liverpool), Jesús Álvarez‐García(University of Liverpool), Maria José Ferré(University of Liverpool), Ekaterine Popova(University of Liverpool), Pablo Alonso‐Coello(University of Liverpool), Ignacio Garutti(University of Liverpool), Patrícia Cruz(Barts Health NHS Trust), Carmen Fernández(Barts Health NHS Trust), María Martín Palencia(Barts Health NHS Trust), Susana Valencia Díaz(Barts Health NHS Trust), Teresa Del Castillo(Queen Mary University of London), A. Quiroga Varela(Washington University in St. Louis), Angeles de Miguel(Washington University in St. Louis), Manuel Múñoz(University College London), Patricia Piñeiro(University College London), Gabriel Cusati(University College London), M Barrio(University College London), Maria José Membrillo(University College London), David Orozco(University College London), Fidel Reyes(University College London), Robert J Sapsford(University College London), Julian H. Barth(University College London), J. Hebbring Scott(University College London), Alistair S. Hall(Washington University in St. Louis), Simon Howell(Washington University in St. Louis), Michaela Lobley(Washington University in St. Louis), Janet Woods(Washington University in St. Louis), Susannah Howard(Washington University in St. Louis), Joanne Fletcher(Washington University in St. Louis), Nikki Dewhirst(Washington University in St. Louis), Colin C. Williams(Washington University in St. Louis), A. Rushton(Washington University in St. Louis), Ingeborg Welters(Washington University in St. Louis), M. Leuwer(Washington University in St. Louis), Rupert Pearse(Washington University in St. Louis), Gareth Ackland(Washington University in St. Louis), Ahsun Khan(Washington University in St. Louis), Edyta Niebrzegowska(Washington University in St. Louis), Sally Benton(Washington University in St. Louis), Andrew Wragg(Washington University in St. Louis), Andrew Archbold(Washington University in St. Louis), Amanda Smith(Washington University in St. Louis), Eleanor McAlees, Cheryl Ramballi, Neil MacDonald, Marta Januszewska, Robert Stephens, Anna Reyes, Laura Gallego Paredes, Pervez Sultan, David Cain, John Whittle, Ana Gutierrez del Arroyo, Daniel I Sessler, Andrea Kurz, Zhuo Sun, Patrick Sean Finnegan, Cameron Egan, Hooman Honar, Aram Shahinyan, Krit Panjasawatwong, Alexander Y. Fu, Sihe Wang, Edmunds Reineks, Peter Nägele, Jane Blood, Megan Kalin, David W. Gibson, Troy S. Wildes
Cited by 976Open Access
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.
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