Association between postoperative haemoglobin concentrations and composite of non-fatal myocardial infarction and all-cause mortality in noncardiac surgical patients: post hoc analysis of the POISE-2 trial

Turan, Alparslan; Rivas, Eva; Devereaux, P.J.; Bravo, Mauro; Mao, Guangmei; Cohen, Barak; Maheshwari, Kamal; Pu, Xuan; Ruetzler, Kurt; Kai, Li; Sessler, Daniel I.

doi:10.1016/j.bja.2020.08.054

Cited by 23 publications

(15 citation statements)

References 30 publications

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“…As reported previously, 9 lower lowest haemoglobin was associated with greater hazard for experiencing AKI when haemoglobin concentrations were less than 11 g dl −1 (spline term P < 0.001, Supplemental Figure 2, http://links.lww.com/EJA/A815). The duration of SBP less than 90 mmHg was also associated with higher hazard of AKI (Table 2).…”

Section: Resultssupporting

confidence: 75%

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Relative contributions of anaemia and hypotension to myocardial infarction and renal injury

Turan

Rivas

Devereaux

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDHypotension and postoperative anaemia are associated with myocardial and renal injury after noncardiac surgery, but the interaction between them remains unknown.OBJECTIVESTo test the hypothesis that a double-hit of postoperative anaemia and hypotension synergistically worsens a 30-day composite of myocardial infarction (MI) and mortality and acute kidney injury (AKI). Characterising the interaction when hypotension and anaemia occur at same time on myocardial infarction and acute kidney injury.DESIGNPost hoc analysis of the POISE-2 trial.SETTINGPatients were enrolled between July 2010 and December 2013 at 135 hospitals in 23 countries.PATIENTSAdults at least 45 years old with known or suspected cardiovascular disease. We excluded patients without available postoperative haemoglobin measurements or hypotension duration records. Exposures were the lowest haemoglobin concentration and the average daily duration of SBP less than 90 mmHg within the first four postoperative days.MAIN OUTCOME MEASURESThe primary outcome was a collapsed composite of nonfatal MI and all-cause mortality during the initial 30 postoperative days; our secondary outcome was AKI.RESULTSWe included 7940 patients. The mean ± SD lowest postoperative haemoglobin was 10 ± 2 g dl−1, and 24% of the patients had SBP less than 90 mmHg with daily duration ranging from 0 to 15 h. Four hundred and nine (5.2%) patients had an infarction or died within 30 postoperative days, and 417 (6.4%) patients developed AKI. Lowest haemoglobin concentrations less than 11 g dl−1, and duration of SBP less than 90 mmHg was associated with greater hazard of composite outcome of nonfatal MI and all-cause mortality, as well as with AKI. However, we did not find significant multiplicative interactions between haemoglobin splines and hypotension duration on the primary composite or on AKI.CONCLUSIONPostoperative anaemia and hypotension were meaningfully associated with both our primary composite and AKI. However, lack of significant interaction suggests that the effects of hypotension and anaemia are additive rather than multiplicative.TRIAL REGISTRATIONClinicaltrials.gov: NCT01082874.

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Section: Resultssupporting

confidence: 75%

“…As reported previously, 9 lower lowest haemoglobin was associated with greater hazard for experiencing AKI when haemoglobin concentrations were less than 11 g dl À1…”

Section: Secondary Outcomesupporting

confidence: 73%

Relative contributions of anaemia and hypotension to myocardial infarction and renal injury

Turan

Rivas

Devereaux

et al. 2023

European Journal of Anaesthesiology

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“…Postoperative bleeding, sepsis, hypoxia, sustained tachycardia, hypotension, severe anemia is associated with PMIs ( 13 , 36 , 37 ). After adjusting for baseline factors, in patients with postoperative anemia (hemoglobin concentration < 110 g L-1), the risk of PMI increased 1.46 times for every 10 g L-1 reduction in postoperative hemoglobin concentration (95% confidence interval: 1.37–1.56; P < 0.001) ( 37 ). Treating anemia with transfusions remains controversial.…”

Section: Postoperative Risk Factorsmentioning

confidence: 99%

Perioperative Myocardial Injury/Infarction After Non-cardiac Surgery in Elderly Patients

Gao

Chen

et al. 2022

Front. Cardiovasc. Med.

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At present, we have entered an aging society. Many diseases suffered by the elderly, such as malignant tumors, cardiovascular diseases, fractures, surgical emergencies and so on, need surgical intervention. With the improvement of Geriatrics, surgical minimally invasive technology and anesthesia level, more and more elderly patients can safely undergo surgery. Elderly surgical patients are often complicated with a variety of chronic diseases, and the risk of postoperative myocardial injury/infarction (PMI) is high. PMI is considered to be the increase of cardiac troponin caused by perioperative ischemia, which mostly occurs during operation or within 30 days after operation, which can increase the risk of short-term and long-term death. Therefore, it is suggested to screen troponin in elderly patients during perioperative period, timely identify patients with postoperative myocardial injury and give appropriate treatment, so as to improve the prognosis. The pathophysiological mechanism of PMI is mainly due to the increase of myocardial oxygen consumption and / the decrease of myocardial oxygen supply. Preoperative and postoperative risk factors of myocardial injury can be induced by mismatch of preoperative and postoperative oxygen supply. The treatment strategy should first control the risk factors and use the drugs recommended in the guidelines for treatment. Application of cardiovascular drugs, such as antiplatelet β- Receptor blockers, statins and angiotensin converting enzyme inhibitors can effectively improve postoperative myocardial ischemia. However, the risk of perioperative bleeding should be fully considered before using antiplatelet and anticoagulant drugs. This review is intended to describe the epidemiology, diagnosis, pathophysiology, risk factors, prognosis and treatment of postoperative myocardial infarction /injury.

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“…In recent observational studies encompassing thousands of surgical patients, the prevalence of preoperative anaemia varied between 10% and 50%, 1 and was associated with increased morbidity and mortality. Trials investigating more liberal allogeneic red blood cell (RBC) transfusion to reverse anaemia have failed to demonstrate substantial clinical benefits.…”

Section: Declaration Of Interestsmentioning

confidence: 99%

“…Turan and colleagues 1,2 and Roshanov and colleagues 3,4 each published a pair of papers that are summarized in Table 1. The first by Turan and colleagues 1 is a sub-analysis from the POISE-2 trial, 7 originally designed to assess aspirin and clonidine in a randomised trial in patients having noncardiac surgery with a composite outcome of 30-day mortality or non-fatal myocardial infarction.…”

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confidence: 99%

Bleeding, anaemia, and transfusion: an ounce of prevention is worth a pound of cure

Frank

Cushing

2021

British Journal of Anaesthesia

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Association between postoperative haemoglobin concentrations and composite of non-fatal myocardial infarction and all-cause mortality in noncardiac surgical patients: post hoc analysis of the POISE-2 trial

Cited by 23 publications

References 30 publications

Relative contributions of anaemia and hypotension to myocardial infarction and renal injury

Relative contributions of anaemia and hypotension to myocardial infarction and renal injury

Perioperative Myocardial Injury/Infarction After Non-cardiac Surgery in Elderly Patients

Bleeding, anaemia, and transfusion: an ounce of prevention is worth a pound of cure

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