Abstract:We conclude that elevated TnT levels in the postoperative period confer a 15-fold increase in mortality during the first year after surgery. Our findings also provide evidence that silent myocardial ischemia is common in an elderly population. Routine perioperative surveillance for TnT might therefore be of use in detecting patients at an increased risk of mortality during the first postoperative year.
“…The 6 eligible studies, [25][26][27][28][29][30] which included a total of 2175 patients and 249 events (Table 2), evaluated CK-MB, 26,27,29,30 troponin T, [28][29][30] troponin I 25,27 or both troponin T and I. 26 In all 6 studies, troponin measurement proved to be a statistically significant independent predictor of intermediate and long-term outcomes (i.e., mortality and major cardiac events).…”
Section: Box 1: Proposed Diagnostic Criteria For Perioperative Myocarmentioning
Review
SynthèseT his is the second of 2 articles in which we evaluate cardiac events in patients undergoing noncardiac surgery. In the first article, we established that patients undergoing noncardiac surgery frequently experience major perioperative cardiac events (i.e., cardiac death, nonfatal myocardial infarction [MI] and nonfatal cardiac arrest). 1 We discussed the still unresolved pathophysiology of these events and suggested strategies for preoperative cardiac risk assessment and communication of risk. In this article, we summarize the evidence regarding monitoring strategies for perioperative MI, propose diagnostic criteria for perioperative MI and review the evidence for perioperative prophylactic cardiac interventions.The breadth of the topics covered in this article prohibited a fully systematic approach to this review. Although this is a narrative review, we did conduct thorough literature searches in each area and contacted the authors of relevant articles when necessary. We sought relevant systematic reviews and have highlighted their findings in our discussion.
“…The 6 eligible studies, [25][26][27][28][29][30] which included a total of 2175 patients and 249 events (Table 2), evaluated CK-MB, 26,27,29,30 troponin T, [28][29][30] troponin I 25,27 or both troponin T and I. 26 In all 6 studies, troponin measurement proved to be a statistically significant independent predictor of intermediate and long-term outcomes (i.e., mortality and major cardiac events).…”
Section: Box 1: Proposed Diagnostic Criteria For Perioperative Myocarmentioning
Review
SynthèseT his is the second of 2 articles in which we evaluate cardiac events in patients undergoing noncardiac surgery. In the first article, we established that patients undergoing noncardiac surgery frequently experience major perioperative cardiac events (i.e., cardiac death, nonfatal myocardial infarction [MI] and nonfatal cardiac arrest). 1 We discussed the still unresolved pathophysiology of these events and suggested strategies for preoperative cardiac risk assessment and communication of risk. In this article, we summarize the evidence regarding monitoring strategies for perioperative MI, propose diagnostic criteria for perioperative MI and review the evidence for perioperative prophylactic cardiac interventions.The breadth of the topics covered in this article prohibited a fully systematic approach to this review. Although this is a narrative review, we did conduct thorough literature searches in each area and contacted the authors of relevant articles when necessary. We sought relevant systematic reviews and have highlighted their findings in our discussion.
“…godzin po zakończeniu zabiegu, co koresponduje z początkiem objawów niedokrwienia tuż po zakończeniu zabiegu [105,106]. Autorzy zajmujący się zagadnieniem powikłań kardiologicznych w okresie okołooperacyjnym poświęcają wiele uwagi obecności podwyż-szonego poziomu troponiny we krwi jako ważnego i specyficznego markera uszkodzenia mięśnia sercowego [113,143,146,168]. Rao i wsp., opierając się na grupie 3021 pacjentów z dolegliwościami stenokardialnymi, zaliczają podwyższony poziom troponiny do niezależnych czynników prognostycznych rozwoju powikłań kardiologicznych.…”
“…Rao i wsp., opierając się na grupie 3021 pacjentów z dolegliwościami stenokardialnymi, zaliczają podwyższony poziom troponiny do niezależnych czynników prognostycznych rozwoju powikłań kardiologicznych. Podobne obserwacje przedstawiają inni autorzy [113,117,146,168]. Nuarei i wsp.…”
“…Studies of perioperative cardiac enzyme release in noncardiac surgery indicate that all grades of myocardial injury probably exist. The level of this release is associated with poor outcome ( 1 Landesberg 2003, Kim 2002, Oscarsson 2004, Howell 2004). During CABG surgery perioperative episodes of myocardial ischemia may occur in 47% of cases before cardiopulmonary bypass (CPB), and in 63% within 8 hours after revascularization (Tupper-Carey 2000).…”
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