Postoperative statin treatment may be associated with improved mortality in patients with myocardial injury after noncardiac surgery

Park, Jungchan; Kim, Jihoon; Lee, Seung Hwa; Lee, Jong Hwan; Min, Jeong Jin; Kwon, Ji‐Hye; Oh, Ah Ran; Seo, Wonho; Hyeon, Cheol Won; Yang, Kwangmo; Choi, Jin-Ho; Lee, Sang‐Chol; Kim, Kyunga; Ahn, Joonghyun; Gwon, Hyeon‐Cheol

doi:10.1038/s41598-020-68511-3

Cited by 15 publications

(11 citation statements)

References 33 publications

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“…Outcomes reported are summarized in Table S1 . Thirty five of the 38 included cohort studies reported mortality 2 , 22 , 28–31 , 33–47 , 49 , 51–55 , 57 , 59–64 , 66 . For MACE rates, myocardial infarction was the most frequently reported outcome (16) 28 , 29 , 31 , 37 , 48 , 50–53 , 56 , 57 , 59–61 , 64 , 65 , followed by heart failure (9) 2 , 28 , 31 , 37 , 48 , 53 , 56 , 64 , 65 and arrhythmia (5) 31 , 36 , 48 , 56 , 65 .…”

Section: Resultsmentioning

confidence: 99%

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

et al. 2023

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Background Myocardial injury after non-cardiac surgery is diagnosed following asymptomatic troponin elevation in the perioperative interval. Myocardial injury after non-cardiac surgery is associated with high mortality rates and significant rates of major adverse cardiac events within the first 30 days following surgery. However, less is known regarding its impact on mortality and morbidity beyond this time. This systematic review and meta-analysis aimed to establish the rates of long-term morbidity and mortality associated with myocardial injury after non-cardiac surgery. Methods MEDLINE, Embase and Cochrane CENTRAL were searched, and abstracts screened by two reviewers. Observational studies and control arms of trials, reporting mortality and cardiovascular outcomes beyond 30 days in adult patients diagnosed with myocardial injury after non-cardiac surgery, were included. Risk of bias was assessed using the Quality in Prognostic Studies tool. A random-effects model was used for the meta-analysis of outcome subgroups. Results Searches identified 40 studies. The meta-analysis of 37 cohort studies found a rate of major adverse cardiac events-associated myocardial injury after non-cardiac surgery of 21 per cent and mortality following myocardial injury after non-cardiac surgery was 25 per cent at 1-year follow-up. A non-linear increase in mortality rate was observed up to 1 year after surgery. Major adverse cardiac event rates were also lower in elective surgery compared with a subgroup including emergency cases. The analysis demonstrated a wide variety of accepted myocardial injury after non-cardiac surgery and major adverse cardiac events diagnostic criteria within the included studies. Conclusion A diagnosis of myocardial injury after non-cardiac surgery is associated with high rates of poor cardiovascular outcomes up to 1 year after surgery. Work is needed to standardize diagnostic criteria and reporting of myocardial injury after non-cardiac surgery-related outcomes. Registration This review was prospectively registered with PROSPERO in October 2021 (CRD42021283995).

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Section: Resultsmentioning

confidence: 99%

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

et al. 2023

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“…Appropriate use of intravenous fluids to maintain fluid and electrolyte balance is important for normal organ function after surgery. Optimal perioperative medical therapy should be adopted for the prevention and management of PMI, including antiplatelet agents, β-Blocker ( 25 – 29 ), statins ( 12 , 30 – 34 ), ACE inhibitors, and anticoagulants. These patients can benefit from intensification of assessment and medical management of multi-morbidity during the perioperative period ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Management of Postoperative Myocardial Injury After Non-cardiac Surgery in Patients Aged ≥ 80 Years: Our 10 Years' Experience

Gao

Chen

Wang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPostoperative myocardial injury (PMI) is associated with short- and long-term mortality. The incidence of PMI in very old patients is currently unknown. There is currently neither known effective prophylaxis nor a uniform strategy for the elderly with PMI.ObjectiveTo share our 10 years of experience in the comprehensive management of PMI after non-cardiac surgery in patients aged ≥ 80 years.MethodsIn this case series, we retrospectively collected and assessed the 2,984 cases aged ≥ 80 years who accepted non-cardiac surgery from 2011 to 2021 at the second Medical Center, Chinese PLA General Hospital. The incidence, risk factors, management strategy, and prognosis of surgical patients with PMI were analyzed.ResultsA total of 2,984 patients met our inclusion criteria. The overall incidence of PMI was 14%. In multivariable analysis, coronary artery disease, chronic heart failure, and hypotension were independently associated with the development of PMI. The patients with PMI were at a higher risk of death (OR, 2.69; 95% CI, 1.78–3.65). They were more likely to have received low molecular heparin, anti-plantlet therapy, beta-blocker, early coronary angiography, and statin than patients without PMI. The 30-day (0.96% vs. 0.35%; OR 3.46; 95% CI, 1.49–7.98; P < 0.001) and 1-year mortality (5.37% vs. 2.60%; OR 2.35; 95% CI, 1.12–6.53; P < 0.001) was significantly higher in patients with PMI compared with those without PMI.ConclusionsThe incidence of PMI in very old patients was high. The PMI is associated with an increased risk of 30 days and 1-year mortality. These patients can benefit from intensification of assessment and individualized care of multi-morbidities during the perioperative period. Especially cardiovascular medical treatments, such as antiplatelet, anticoagulation, β-blockers, and statins are very important for patients with PMI.

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“…The only treatment that was established in randomized trials was direct oral anticoagulants [ 16 ]. However, strengthening of cardiovascular drugs such as aspirin, statins, and few types of hypertension drugs have been reported to be linked to reduced mortality in patients with MINS [ 10 , 20 ]. Our results, show that the prescription of cardiovascular drugs such as antiplatelet agents, antihypertensive drugs, and statins at discharge are effective in predicting MINS mortality.…”

Section: Discussionmentioning

confidence: 99%

Predictability of Mortality in Patients With Myocardial Injury After Noncardiac Surgery Based on Perioperative Factors via Machine Learning: Retrospective Study

Shin¹,

Park²,

Lee³

et al. 2021

JMIR Med Inform

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Background Myocardial injury after noncardiac surgery (MINS) is associated with increased postoperative mortality, but the relevant perioperative factors that contribute to the mortality of patients with MINS have not been fully evaluated. Objective To establish a comprehensive body of knowledge relating to patients with MINS, we researched the best performing predictive model based on machine learning algorithms. Methods Using clinical data from 7629 patients with MINS from the clinical data warehouse, we evaluated 8 machine learning algorithms for accuracy, precision, recall, F1 score, area under the receiver operating characteristic (AUROC) curve, and area under the precision-recall curve to investigate the best model for predicting mortality. Feature importance and Shapley Additive Explanations values were analyzed to explain the role of each clinical factor in patients with MINS. Results Extreme gradient boosting outperformed the other models. The model showed an AUROC of 0.923 (95% CI 0.916-0.930). The AUROC of the model did not decrease in the test data set (0.894, 95% CI 0.86-0.922; P=.06). Antiplatelet drugs prescription, elevated C-reactive protein level, and beta blocker prescription were associated with reduced 30-day mortality. Conclusions Predicting the mortality of patients with MINS was shown to be feasible using machine learning. By analyzing the impact of predictors, markers that should be cautiously monitored by clinicians may be identified.

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Postoperative statin treatment may be associated with improved mortality in patients with myocardial injury after noncardiac surgery

Cited by 15 publications

References 33 publications

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

Long-term major adverse cardiovascular events following myocardial injury after non-cardiac surgery: meta-analysis

Management of Postoperative Myocardial Injury After Non-cardiac Surgery in Patients Aged ≥ 80 Years: Our 10 Years' Experience

Predictability of Mortality in Patients With Myocardial Injury After Noncardiac Surgery Based on Perioperative Factors via Machine Learning: Retrospective Study

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