Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

Lavallaz, Jeanne du Fay de; Puelacher, Christian; Buse, Giovanna Lurati; Bolliger, Daniel; Germanier, Dominic; Hidvegi, Reka; Walter, Joan; Twerenbold, Raphael; Strebel, Ivo; Badertscher, Patrick; Sazgary, Lorraine; Lampart, Andreas; Espinola, Jaqueline; Kindler, Christoph; Hammerer-Lercher, Angelika; Thambipillai, Saranya; Guerke, Lorenz; Rentsch, Katharina; Buser, Andreas; Gualandro, Danielle Menosi; Jakob, Marcel; Müeller, Christian

doi:10.1136/heartjnl-2018-313876

Cited by 13 publications

(12 citation statements)

References 28 publications

(9 reference statements)

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“…These results illustrate the new system can replace EuroSCORE II, and has a higher ability to distinguish high-risk patients. Generally, the risk of operation in AMI patients is higher than of other patients [ 36 ]. Subset analysis found the new system significantly improved the predictive power in the AMI subset.…”

Section: Discussionmentioning

confidence: 99%

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Shan

et al. 2020

BMC Cardiovasc Disord

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Background Preoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG). Methods This retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis. Results There were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively). Conclusions Both myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.

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Section: Discussionmentioning

confidence: 99%

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Shan

et al. 2020

BMC Cardiovasc Disord

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“…Before the analysis, we defined surgeries in the “morning” period as procedures for which the first incision occurred between 7 a.m. and 12 a.m.; and surgeries in the “afternoon/night” period as procedures for which the first incision occurred between 12:01 p.m. and 6:59 a.m. of the next day. These time intervals reflect the Hospital work shifts of the surgical at our study center and are an example of the pattern of categorization between morning and afternoon surgeries previously described in the literature [ 15 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…A recent pilot study including patients submitted to aortic valve replacement assessed whether this time pattern occur after cardiac surgeries, showing that the incidence of major cardiovascular complications in patients undergoing surgery in the afternoon is lower [ 15 ]. Likewise, a cohort study conducted to assess daytime variation in cardiovascular events after non-cardiac surgeries did not find an influence of the time of the surgery on PMI, but the incidence of acute myocardial infarction was higher in the afternoon group [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of the period of the day on all-cause mortality and major cardiovascular complications after arterial vascular surgeries

et al. 2023

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Background Conflicting results are reported about daytime variation on mortality and cardiac outcomes after non-cardiac surgeries. In this cohort study, we evaluate whether the period of the day in which surgeries are performed may influence all-cause mortality and cardiovascular outcomes in patients undergoing non-cardiac arterial vascular procedures. Methods 1,267 patients who underwent non-cardiac arterial vascular surgeries between 2012 and 2018 were prospectively included in our cohort and categorized into two groups: morning (7 a.m. to 12 a.m., 79%) and afternoon/night (12:01 p.m. to 6:59 a.m. in the next day, 21%) surgeries. Primary endpoint was all-cause mortality within 30 days and one year. Secondary endpoints were the incidence of perioperative myocardial injury/infarction (PMI), and the incidence of major adverse cardiac events (MACE, including acute myocardial infarction, acute heart failure, arrhythmias, cardiovascular death) at hospital discharge. Results After adjusting for confounders in the multivariable Cox proportional regression, all-cause mortality rates at 30 days and one year were higher among those who underwent surgery in the afternoon/night (aHR 1.6 [95%CI 1.1–2.3], P = 0.015 and aHR 1.7 [95%CI 1.3–2.2], P < 0.001, respectively). Afternoon/night patients had higher incidence of PMI (aHR 1.4 [95%CI 1.1–1.7], P < 0.001). There was no significant difference in the incidence of MACE (aHR 1.3 [95%CI 0.9–1.7], P = 0.074). Conclusions In patients undergoing arterial vascular surgery, being operated in the afternoon/night was independently associated with increased all-cause mortality rates and incidence of perioperative myocardial injury/infarction.

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“…Montaigne et al did have reported that the incidence of major adverse cardiac events in the afternoon surgery group was significantly lower than that in the morning group [80]. More interestingly, in patients undergoing non-cardiac surgery, Lavallaz et al found that the incidence of AMI during follow-up is instead increased in the afternoon surgeries [81]. Nevertheless, a better understanding of the relationship between circadian clock and cardiovascular disease may help to develop more targeted and personalized treatment strategies for patients.…”

Section: Disruption Of Circadian Bp Rhythm and Cardiovascular Diseasementioning

confidence: 95%

Circadian Blood Pressure Rhythm in Cardiovascular and Renal Health and Disease

et al. 2021

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Blood pressure (BP) follows a circadian rhythm, it increases on waking in the morning and decreases during sleeping at night. Disruption of the circadian BP rhythm has been reported to be associated with worsened cardiovascular and renal outcomes, however the underlying molecular mechanisms are still not clear. In this review, we briefly summarized the current understanding of the circadian BP regulation and provided therapeutic overview of the relationship between circadian BP rhythm and cardiovascular and renal health and disease.

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Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

Cited by 13 publications

References 28 publications

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Impact of the period of the day on all-cause mortality and major cardiovascular complications after arterial vascular surgeries

Circadian Blood Pressure Rhythm in Cardiovascular and Renal Health and Disease

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