Peri‐operative silent myocardial ischaemia and long‐term adverse outcomes in non‐cardiac surgical patients*

Higham, Helen; Sear, J.W.; Neill, Fiona; Sear, Y. M.; Foëx, P.

doi:10.1046/j.1365-2044.2001.01977.x

Cited by 24 publications

(30 citation statements)

References 40 publications

(45 reference statements)

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“…Identification of a comparator group of non-cardiac surgical patients where peri-operative silent myocardial ischaemia and long-term cardiovascular outcomes were reported To make a valid comparison with other studies where the association between peri-operative SMI and major cardiovascular complications up to 12 months after surgery have been reported, we took data from three comparable published observational studies carried out in Oxford [6,13,14]. The studies were selected as the majority of the patients had undergone intermediate-risk surgery [3] or had £2 clinical risk factors using Lee's RCRI [12].…”

Section: Methodsmentioning

confidence: 99%

“…Studies of silent myocardial ischaemia (the comparator group) Patient demographics and surgical risk The SMI study by Higham et al [6] together with additional data from Higham et al [13] and Howell et al [14] provides us with data on late cardiovascular outcomes (up to 12 months) in 281 patients following vascular surgery and intermediate-risk surgical procedures (general and orthopaedic surgery) where peri-operative SMI (ambulatory ECG monitoring) was reported. The final data set comprised 107 patients exhibiting peri-operative SMI and 174 controls.…”

Section: Patient Demographics and Surgical Riskmentioning

confidence: 99%

“…In the comparator studies [6,13,14] of peri-operative SMI, the patients were followed for 12 months after surgery to determine the incidence of major cardiovascular complications (cardiac death, myocardial infarction, heart failure, ECG ischaemia or unstable angina needing treatment, cardiac arrhythmias needing treatment and cerebrovascular events).…”

Section: Data Collectionmentioning

confidence: 99%

“…These include silent myocardial ischaemia (SMI), abnormal ventricular wall motion, and cardiac biomarkers such as C-reactive protein (CRP), brain natriuretic peptide, troponins, and creatine kinase-MB. We and others have shown a significant association between SMI and outcome [4][5][6]. Furthermore Landesberg et al [5] have shown that prolonged postoperative myocardial ischaemia (> 30 min) is an independent predictor of long-term mortality following major vascular surgery.…”

mentioning

confidence: 99%

“…Postoperative myocardial ischaemia has also been associated with major cardiovascular complications within three months of surgery in patients undergoing both major and intermediate risk surgery [7]. SMI may also be predictive of adverse cardiovascular events up to a year after a range of non-cardiac surgical operations [6].…”

mentioning

confidence: 99%

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Acute peri‐operative beta blockade in intermediate‐risk patients

Biccard¹,

Sear²,

Foëx³

2006

Anaesthesia

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SummaryPeri-operative beta-blockade has been shown to reduce the incidence of postoperative cardiovascular complications including cardiac death in high-risk non-cardiac surgical patients. However, the recent analysis by Lindenauer et al. suggests that it is inappropriate to administer beta-blockers blindly to all surgical patients. In an attempt to determine the appropriateness of peri-operative beta-blocker administration across patients with a spectrum of cardiovascular risks, we have examined studies of intermediate-risk patient groups (that is those undergoing intermediate risk surgery or those with a Lee Revised Cardiac Risk Score of £2). We analysed data from randomised prospective studies of the effects of acute peri-operative beta-blockade on the incidence of peri-operative myocardial ischaemia. By examining the demographics and surgical interventions in these patients, we have compared these studies with other studies of peri-operative silent myocardial ischaemia representing patients of similar risk. We thus estimated the expected longterm postoperative cardiovascular complication rate associated with myocardial ischaemia in these patients in terms of number needed to treat for ischaemia prevention and for prevention of major cardiovascular complications. Prevention of peri-operative myocardial ischaemia with acute betablockade in non-cardiac surgical patients with 1-2 RCRI clinical risk factors can be achieved with a number needed to treat of 10.

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Section: Methodsmentioning

confidence: 99%

Section: Patient Demographics and Surgical Riskmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Acute peri‐operative beta blockade in intermediate‐risk patients

Biccard¹,

Sear²,

Foëx³

2006

Anaesthesia

Self Cite

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Enhanced recovery after surgery, current, and future considerations in head and neck cancer

List,

Knackstedt,

Liu

et al. 2023

Laryngoscope Investig Oto

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ObjectivesReview of the current and relevant literature to develop a list of evidence‐based recommendations that can be implemented in head and neck surgical practices. To provide rationale for the multiple aspects of comprehensive care for head and neck surgical patients. To improve postsurgical outcomes for head and neck surgical patients.MethodsExtensive review of the medical literature was performed and relevant studies in both the head and neck surgery and other surgical specialties were considered for inclusion.ResultsA total of 18 aspects of perioperative care were included in this review. The literature search included 276 publications considered to be the most relevant and up to date evidence. Each topic is concluded with recommendation grade and quality of evidence for the recommendation.ConclusionSince it's conception, enhanced recovery after surgery (ERAS) protocols have continued to push for comprehensive and evidence based postsurgical care to improve patient outcomes. Head and neck oncology is one of the newest fields to develop a protocol. Due to the complexity of this patient population and their postsurgical needs, a multidisciplinary approach is needed to facilitate recovery while minimizing complications. Current and future advances in head and neck cancer research will serve to strengthen and add new principles to a comprehensive ERAS protocol.Level of Evidence2a.

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Perioperative Myokardschäden bei nichtkardiochirurgischen Patienten

Roggenbach

Böttiger²,

Teschendorf³

2009

Anaesthesist

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Perioperative myocardial damage occurs with a high incidence depending on the operative procedure and the patients examined and is considered to be among the most relevant risk factors for increased perioperative morbidity and mortality in patients undergoing non-cardiac surgery. The pathophysiology of myocardial damage in the perioperative period is still not well understood. Both ischemia with and without acute coronary occlusion and non-ischemic stimuli can put a substantial strain on the heart in the perioperative period. However, in many cases the clinical presentation does not allow a clear differentiation between ischemic and non-ischemic myocardial damage. In the majority of cases perioperative myocardial infarctions occur with only mild or even without any clinical symptoms. This is probably due to a considerable difference in phenotype and pathophysiology between perioperative and non-perioperative myocardial infarctions. As a result of this unexplained etiology of perioperative myocardial infarction it remains an open question whether the contemporary diagnostic and therapeutic recommendations for the acute coronary syndrome can be extrapolated to the perioperative situation. The present review reflects the current state of knowledge and presents an optional approach to the diagnosis and therapy of perioperative myocardial injury.

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Peri‐operative silent myocardial ischaemia and long‐term adverse outcomes in non‐cardiac surgical patients*

Cited by 24 publications

References 40 publications

Acute peri‐operative beta blockade in intermediate‐risk patients

Acute peri‐operative beta blockade in intermediate‐risk patients

Enhanced recovery after surgery, current, and future considerations in head and neck cancer

Perioperative Myokardschäden bei nichtkardiochirurgischen Patienten

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