Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis

Ekeloef, Sarah; Alamili, Mahdi; Devereaux, P.J.; Gögenur, Ismail

doi:10.1093/bja/aew321

Cited by 184 publications

(76 citation statements)

References 40 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,[3][4][5]9 The incidence of PMI observed in our study was comparable to that observed, eg, in VISION if using a comparable absolute hs-cTnT-delta criterion. 1,[3][4][5]9 Differences in observed incidence rates found in several previous studies seem to relate to differences in the study populations, definitions of PMI, and the cTn assays used. 1,[3][4][5]9 The VISION study included patients >45 years (mean age, 63 years) irrespective of preexisting coronary artery disease or peripheral artery disease, and therefore at lower cardiovascular risk than in this study (median age, 74 years).…”

Section: Discussionsupporting

confidence: 87%

“…These findings extend and corroborate previous work on PMI, particularly the VISION study (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation). 1,[3][4][5]9 The incidence of PMI observed in our study was comparable to that observed, eg, in VISION if using a comparable absolute hs-cTnT-delta criterion. 1,[3][4][5]9 Differences in observed incidence rates found in several previous studies seem to relate to differences in the study populations, definitions of PMI, and the cTn assays used.…”

supporting

confidence: 87%

“…1,[3][4][5]9 Differences in observed incidence rates found in several previous studies seem to relate to differences in the study populations, definitions of PMI, and the cTn assays used. 1,[3][4][5]9 The VISION study included patients >45 years (mean age, 63 years) irrespective of preexisting coronary artery disease or peripheral artery disease, and therefore at lower cardiovascular risk than in this study (median age, 74 years). Accordingly, 30-day mortality in this study was twice that observed in VISION.…”

mentioning

confidence: 81%

“…These prospective observations corroborate that these acute events would in the vast majority have been missed in the absence of systematic screening. [1][2][3][4][5] Third, patients with PMI had 6 times the 30-day mortality observed in patients without PMI, despite the early 1,[5][6][7][8]20 Fourth, PMI associated with a primarily extracardiac disorder triggering cardiomyocyte injury such as severe sepsis has even worse prognosis with 1 of 3 patients dying within 30 days.Fifth, acute cardiomyocyte injury occurring in the perioperative period (PMI) had additive and possibly amplifying detrimental effects on 30-day and 1-year mortality on top of chronic cardiomyocyte injury attributable to various chronic cardiovascular disorders present before the operation. Accordingly, PMI was associated with increased mortality in patients presenting with low preoperative hs-cTnT concentrations, and elevated preoperative hs-cTnT concentrations, as well.…”

mentioning

confidence: 99%

“…[1][2][3][4][5] In contrast with spontaneous myocardial infarction (MI), PMI most commonly does not exhibit typical symptoms of myocardial ischemia, such as chest pain, angina pectoris, or dyspnea, and is therefore missed in routine clinical practice in most institutions in the United States and worldwide. [1][2][3][4][5] Considering that >300 million surgeries are performed annually and that demographic change is resulting in an increasing number of surgical patients with elevated cardiovascular risk, strategies to improve the detection, treatment, and outcome of PMI may have the potential to provide major medical benefits. A missed diagnosis inevitably leads to a missed chance for treatment.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Perioperative Myocardial Injury After Noncardiac Surgery

et al. 2018

View full text Add to dashboard Cite

1 ORIGINAL RESEARCH ARTICLE ORIGINAL RESEARCH ARTICLEEditorial, see p XXX BACKGROUND: Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening. METHODS:We performed a prospective diagnostic study enrolling consecutive patients undergoing noncardiac surgery who had a planned postoperative stay of ≥24 hours and were considered at increased cardiovascular risk. All patients received a systematic screening using serial measurements of high-sensitivity cardiac troponin T in clinical routine. PMI was defined as an absolute high-sensitivity cardiac troponin T increase of ≥14 ng/L from preoperative to postoperative measurements. Furthermore, mortality was compared among patients with PMI not fulfilling additional criteria (ischemic symptoms, new ECG changes, or imaging evidence of loss of viable myocardium) required for the diagnosis of spontaneous acute myocardial infarction versus those that did. RESULTS:From 2014 to 2015 we included 2018 consecutive patients undergoing 2546 surgeries. Patients had a median age of 74 years and 42% were women. PMI occurred after 397 of 2546 surgeries (16%; 95% confidence interval, 14%-17%) and was accompanied by typical chest pain in 24 of 397 patients (6%) and any ischemic symptoms in 72 of 397 (18%). Crude 30-day mortality was 8.9% (95% confidence interval [CI], 5.7-12.0) in patients with PMI versus 1.5% (95% CI, 0.9-2.0) in patients without PMI (P<0.001). Multivariable regression analysis showed an adjusted hazard ratio of 2.7 (95% CI, 1.5-4.8) for 30-day mortality. The difference was retained at 1 year with mortality rates of 22.5% (95% CI, 17.6-27.4) versus 9.3% (95% CI, 7.9-10.7). Thirty-day mortality was comparable among patients with PMI not fulfilling any other of the additional criteria required for spontaneous acute myocardial infarction (280/397, 71%) versus those with at least 1 additional criterion (10.4%; 95% CI, versus 8.7%; 95% CI, P=0.684). CONCLUSIONS:PMI is a common complication after noncardiac surgery and, despite early detection during routine clinical screening, is associated with substantial short-and long-term mortality. Mortality seems comparable in patients with PMI not fulfilling any other of the additional criteria required for spontaneous acute myocardial infarction versus those patients who do. CLINICAL TRIAL REGISTRATION: Perioperative myocardial injury (PMI) has recently been identified as an important, yet often undetected complication after noncardiac surgery, strongly associated with 30-day mortality. [1][2][3][4][5] In contrast with spontaneous myocardial infarction (MI), PMI most commonly does not exhibit typical symptoms of myocardial ischemia, such as chest pain, angina pectoris, or dyspnea, and is therefore missed in routine clinical practice in most institutions in the United States and worldwide. [1][2][3][4][5] Considering that >300 million surgeries are performed annually and that de...

show abstract