Use of ivabradine and atorvastatin in emergent orthopedic lower limb surgery and computed tomography coronary plaque imaging and novel biomarkers of cardiovascular stress and lipid metabolism for the study and prevention of perioperative myocardial infarction: study protocol for a randomized controlled trial

Abstract

BackgroundThe incidence of perioperative myocardial infarction (PMI) globally is known to be around 2 to 3% and can prolong hospitalization, increased morbidity and mortality. Little is known about the pathophysiology and risk factors for PMI. We investigate the presence of elevated novel cardiac markers and preoperative coronary artery plaque through contemporary laboratory techniques to determine the correlation with PMI, as well as studying ivabradine and atorvastatin as protective pharmacotherapies against PMI in the context of orthopedic surgery.Methods/DesignWe aim to enroll 200 patients aged above 60 years who suffer from neck of femur fracture requiring surgery. Patients will be randomized to four arms (no study drugs, atorvastatin only, ivabradine only and ivabradine and atorvastatin). Our primary outcome is incidence of PMI. All patients will receive an electrocardiogram, cardiac echocardiography, measurement of novel cardiac biomarkers and computed tomography (CT) coronary angiography. A telephone interview post discharge will be conducted at 30 days, 60 days and 1 year.DiscussionWe postulate that ivabradine and atorvastatin will reduce the rate and magnitude of PMI following surgery by reducing heart rate and attenuating catecholamine-induced tachycardia postoperatively. Secondly, we postulate that postoperative reduction in heart rate and catecholamine-induced tachycardia with ivabradine will correlate with a reduction in cardiovascular novel biomarkers which will reduce atrial stretch and postoperative incidence of arrhythmia. We aim to demonstrate that treatment with ivabradine and atorvastatin will cause a reduction in the incidence and magnitude of PMI, the benefit of which is derived primarily in patients with greater atherosclerotic burden as measured by higher CT coronary calcium scores.Trial registrationThis study protocol has been listed in the Australia New Zealand Clinical Trial Registry (registration number: ACTRN12612000340831) on 23 March 2012.

Preadmission Statin Prescription and Inpatient Myocardial Infarction in Geriatric Hip Fracture

“…Patients will be assessed with ECG, cardiac echo, cardiac biomarkers and CT coronary angiography. The primary outcome will be post-operative TnI measurements to define myocardial injury [ 28 ], however this has not been reported seven years post publication of methodology.…”

“…The focus of the failed POST-OP RCT [ 27 ] and unreported RCT of Rudd et al [ 28 ] is the anti-inflammatory effects of statins, proposed to help increase long-term survival [ 5 ]. Hip fracture is associated with a heightened inflammatory response which represents an independent predictor for mortality and morbidity [ 30 ], however, the long-term anti-inflammatory effects of the statins in an immune-primed and cardiovascularly-vulnerable hip fracture cohort was not able to be examined by this study.…”

Prediction of Heart Failure in Children with Congenital Heart Disease Based on Multichannel LSTM

“…Mobile Information Systems scientific reference for the prevention of CHD and the development of relevant therapies [21], as well as to give a reference for preconception and prenatal health care. [10,11,22].…”

“…Zhao et al performed neonatal screening for CHD and showed that the prevalence of CHD in children in Shanghai was 26.6‰ and showed that the prevalence of CHD in infants aged 0-1 year was 8.15‰ in Guangdong Province [7,8]. The incidence of perinatal CHD in Gansu Province increased year by year from 12.66 per million in 2005 to 17.38 per million in 2010 [9,10], and the ranking increased from third in 2005 to first in 2010. Currently, most of the findings suggest that CHD is caused by a combination of genetic and environmental factors [11].…”