Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS)

Hua, Alina; Pattenden, Holly; Leung, Maurice P.; Davies, Simon; George, David A.; Raubenheimer, Hilgardt; Niwaz, Zakiyah; Lim, Eric

doi:10.21037/jtd.2016.03.55

Cited by 23 publications

(12 citation statements)

References 19 publications

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“…Considering the etiology of MINS, antithrombotic agents (i.e., rivaroxaban) and anticoagulants (i.e., dabigatran) can be used for treatment. Aspirin and statin therapies and early cardiology assessment and intervention of patients decrease 30-day mortality of MINS patients 17 , 18 .…”

Section: Discussionmentioning

confidence: 99%

The Charlson Comorbidity Index is associated with risk of 30-day mortality in patients with myocardial injury after non-cardiac surgery

Kim

Park

Kwon

et al. 2021

Sci Rep

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Myocardial injury after non-cardiac surgery (MINS) is a well-known and relevant indicator of early postoperative mortality, but factors related to increased mortality in MINS patients are as yet unknown. The Charlson Comorbidity Index (CCI) is widely used to classify various comorbid conditions and underlying diseases. Our study aimed to determine the prognostic value of CCI with regard to mortality of patients with MINS. This study comprises 5633 patients who had MINS as diagnosed by a rise of postoperative cardiac troponin I above the normal range (≥ 0.04 ng/mL) from January 2010 to June 2019. Patients were divided into two groups according to median weighted CCI score: low CCI (≤ 2) and high CCI (> 2) groups. The primary outcome was 30-day mortality after surgery, and secondary outcomes were 1-year and overall mortalities. Of the 5633 patients, 3428 (60.9%) were in the low CCI group (1.21 ± 0.84) and 2205 (39.1%) were in the high CCI group (4.17 ± 1.82). After propensity score matching, mortality during the first 30 days after surgery was significantly greater in the high CCI group than the low CCI group (9.4% vs. 6.0%, respectively; hazard ratio 1.56, 95% confidence interval 1.23–1.98, p < 0.001). A high CCI score was associated with increased 30-day mortality in patients with MINS, suggesting that the CCI may need to be considered when predicting outcomes of MINS patients.

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Section: Discussionmentioning

confidence: 99%

The Charlson Comorbidity Index is associated with risk of 30-day mortality in patients with myocardial injury after non-cardiac surgery

Kim

Park

Kwon

et al. 2021

Sci Rep

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“…In this setting, early evaluation by a cardiologist has been shown to improve outcomes. 10 Documentation Documentation of non-ST elevation MI (NSTEMI) for every case of elevated troponin, rather than using the more specific T1MI, T2MI, or NIMI terminology, can have adverse consequences for health systems. From a coding perspective, the terms STEMI and NSTEMI mean T1MI, and the ICD-10 codes used to identify T1MI patients for value-focused programs frequently include patients with T2MI and NIMI due to impre- cise documentation.…”

Section: Treatmentmentioning

confidence: 99%

Clinical Progress Notes: Updates from the 4th Universal Definition of Myocardial Infarction

King

Levy²,

Trost

2019

Journal of Hospital Medicine

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In this clinical practice update, we aim to review the updated definition of Type 2 MI (T2MI) and nonischemic myocardial injury (NIMI), since these are the two predominant diagnoses among patients with elevated troponin in the absence of T1MI. We also provide a clinical framework for clinicians to think through elevated serum cardiac troponin levels and identify opportunities for quality improvement around this critical issue.

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“…Routine, serial determination of markers of myocardial injury in patients after high-risk procedures now seems difficult to achieve for financial reasons. Nevertheless, in view of the obtained results, the monitoring of myocardial injury (MINS, myocardial injury after noncardiac surgery) in the group of patients with elevated monocytes should be considered [17].…”

Section: Leukocytic Parameters and The Individual Risk Of Patientsmentioning

confidence: 99%

Can the leukocyte`s parameters in peripheral blood smear predict risk of in-hospital death of patients undergoing high-risk gastrointestinal surgery?

Pluta

Krzych

2018

Pol Przegl Chir

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Introduction. White blood cell (WBC) count constitutes a part of routine peripheral blood examination (FBC, full blood count). Precise analysis of leukocytes’ parameters in blood smear is usually performed only when leukopenia or leukocytosis is found. We aimed to assess the usefulness of leukocytes’ smear test in predicting in-hospital death of patients undergoing high-risk gastrointestinal (GI) surgery. Materials & Methods. We prospectively enrolled 101 subjects undergoing high-risk GI surgery from 01.01.2017 till 31.12.2017. Blood tests were performed preoperatively, with analysis focused on the assessment of total WBC count, as well as the count of neutrophils (NEUT), lymphocytes (LYM), monocytes (MONO), eosinophils (EOS) and basophils (BASO). Indices of NEUT/LYM (NLR) and MONO/LYM (MLR) were calculated. In-hospital mortality was considered the outcome. Results. Mortality reached 5%. There was no significant difference in WBC count between survivors and the deceased (p=0.2) and WBC failed to predict the outcome (AUC=0.69; p=0.3). MONO (p=0.009) and BASO (p=0.02) counts, as well as MLR (p=0.007) were significantly higher in patients who died. MONO count and MLR index predicted in-hospital death with good accuracy, respectively: AUC[MONO]=0.85 (p<0.001) and AUC[MLR]=0.86 (p<0.001). Other investigated parameters played no significant role in outcome prediction. Conclusion. Routine peripheral blood smear evaluation should be considered in all patients undergoing high-risk GI surgery, because the number of monocytes can be a valuable predictor of in-hospital death.

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Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS)

Abstract: MINS is common after general thoracic surgery. Early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in 30-day mortality for patients who developed MINS.

Cited by 23 publications

References 19 publications

The Charlson Comorbidity Index is associated with risk of 30-day mortality in patients with myocardial injury after non-cardiac surgery

The Charlson Comorbidity Index is associated with risk of 30-day mortality in patients with myocardial injury after non-cardiac surgery

Clinical Progress Notes: Updates from the 4th Universal Definition of Myocardial Infarction

Can the leukocyte`s parameters in peripheral blood smear predict risk of in-hospital death of patients undergoing high-risk gastrointestinal surgery?

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