Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes
BACKGROUND:Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study’s four objectives were to determine the diagnostic criteria, characteristics, predictors, and...
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| Veröffentlicht in: | Anesthesiology (Philadelphia) 2014-03, Vol.120 (3), p.564-578 |
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| creator | Villar, Juan Carlos Xavier, Denis Guyatt, Gordon Cruz, Patricia Berwanger, Otavio Biccard, Bruce M Malaga, German Sessler, Daniel I Ackland, Gareth L Pettit, Shirley Walsh, Michael Thomas, Sabu Devereaux, P J McQueen, Matthew J Chow, Clara K Mooney, John Santucci, Eliana Santo, Jose Amalth do Espirirto McAlister, Finlay McMurtry, Sean Bessissow, Amal Eikelboom, John Ganame, Javier Hankinson, James Jolly, Sanjit Kearon, Clive Mizera, Richard O’Donnell, Martin Pinthus, Jehonathan Simunovic, Marko Tandon, Vikas Patel, Ameen Raymer, Karen Clase, Catherine Jackson, Paul Lim, Wendy Mazzadi, Sergio Garg, Amit Lam, Ngan Roshanov, Pavel S Ramsey, Clare McKay, Andrew Zacharias, James Vásquez, Skarlett Castañeda, Alvaro Ferreira, Silvia Coriat, Pierre Goarin, Jean Pierre Royer, Catherine Daas, Georges Choi, Gordon Y S Lit, Lydia C W Sigamani, Alben Cherian, Joseph George, Preetha Schünemann, Holger Vizza, Enrico Ong, G. S Y Mansor, Marzida Rotta-Rotta, Aida Musial, Jacek Chwala, Maciej Cassimjee, Hussein Kisten, Theroshnie Naidoo, Prebashini Naidoo, Rubeshan Rodseth, Reitze Skinner, David Torborg, Alex Maestre, Mari Luz Santaló, Miquel Gonzalez, Raúl Pelaez, Xavier Varela, Alberto de Miguel, Angeles Piñeiro, Patricia Cusati, Gabriel del Barrio, Maria Reyes, Fidel Sapsford, Robert J Barth, Julian Scott, Julian Hall, Alistair Howell, Simon Woods, Janet Rushton, A Khan, Ahsun Niebrzegowska, Edyta Archbold, Andrew McAlees, Eleanor Reyes, Anna Paredes, Laura Gallego Sultan, Pervez del Arroyo, Ana Gutierrez Egan, Cameron Honar, Hooman Fu, Alexander Y Reineks, Edmunds Blood, Jane Gibson, David |
| description | BACKGROUND:Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study’s four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS.
METHODS:In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated “abnormal” laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria.
RESULTS:An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors’ diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96–5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6–41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom.
CONCLUSION:Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality. |
| doi_str_mv | 10.1097/ALN.0000000000000113 |
| format | Article |
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S Y ; Mansor, Marzida ; Rotta-Rotta, Aida ; Musial, Jacek ; Chwala, Maciej ; Cassimjee, Hussein ; Kisten, Theroshnie ; Naidoo, Prebashini ; Naidoo, Rubeshan ; Rodseth, Reitze ; Skinner, David ; Torborg, Alex ; Maestre, Mari Luz ; Santaló, Miquel ; Gonzalez, Raúl ; Pelaez, Xavier ; Varela, Alberto ; de Miguel, Angeles ; Piñeiro, Patricia ; Cusati, Gabriel ; del Barrio, Maria ; Reyes, Fidel ; Sapsford, Robert J ; Barth, Julian ; Scott, Julian ; Hall, Alistair ; Howell, Simon ; Woods, Janet ; Rushton, A ; Khan, Ahsun ; Niebrzegowska, Edyta ; Archbold, Andrew ; McAlees, Eleanor ; Reyes, Anna ; Paredes, Laura Gallego ; Sultan, Pervez ; del Arroyo, Ana Gutierrez ; Egan, Cameron ; Honar, Hooman ; Fu, Alexander Y ; Reineks, Edmunds ; Blood, Jane ; Gibson, David</creator><creatorcontrib>Villar, Juan Carlos ; Xavier, Denis ; Guyatt, Gordon ; Cruz, Patricia ; Berwanger, Otavio ; Biccard, Bruce M ; Malaga, German ; Sessler, Daniel I ; Ackland, Gareth L ; Pettit, Shirley ; Walsh, Michael ; Thomas, Sabu ; Devereaux, P J ; McQueen, Matthew J ; Chow, Clara K ; Mooney, John ; Santucci, Eliana ; Santo, Jose Amalth do Espirirto ; McAlister, Finlay ; McMurtry, Sean ; Bessissow, Amal ; Eikelboom, John ; Ganame, Javier ; Hankinson, James ; Jolly, Sanjit ; Kearon, Clive ; Mizera, Richard ; O’Donnell, Martin ; Pinthus, Jehonathan ; Simunovic, Marko ; Tandon, Vikas ; Patel, Ameen ; Raymer, Karen ; Clase, Catherine ; Jackson, Paul ; Lim, Wendy ; Mazzadi, Sergio ; Garg, Amit ; Lam, Ngan ; Roshanov, Pavel S ; Ramsey, Clare ; McKay, Andrew ; Zacharias, James ; Vásquez, Skarlett ; Castañeda, Alvaro ; Ferreira, Silvia ; Coriat, Pierre ; Goarin, Jean Pierre ; Royer, Catherine ; Daas, Georges ; Choi, Gordon Y S ; Lit, Lydia C W ; Sigamani, Alben ; Cherian, Joseph ; George, Preetha ; Schünemann, Holger ; Vizza, Enrico ; Ong, G. S Y ; Mansor, Marzida ; Rotta-Rotta, Aida ; Musial, Jacek ; Chwala, Maciej ; Cassimjee, Hussein ; Kisten, Theroshnie ; Naidoo, Prebashini ; Naidoo, Rubeshan ; Rodseth, Reitze ; Skinner, David ; Torborg, Alex ; Maestre, Mari Luz ; Santaló, Miquel ; Gonzalez, Raúl ; Pelaez, Xavier ; Varela, Alberto ; de Miguel, Angeles ; Piñeiro, Patricia ; Cusati, Gabriel ; del Barrio, Maria ; Reyes, Fidel ; Sapsford, Robert J ; Barth, Julian ; Scott, Julian ; Hall, Alistair ; Howell, Simon ; Woods, Janet ; Rushton, A ; Khan, Ahsun ; Niebrzegowska, Edyta ; Archbold, Andrew ; McAlees, Eleanor ; Reyes, Anna ; Paredes, Laura Gallego ; Sultan, Pervez ; del Arroyo, Ana Gutierrez ; Egan, Cameron ; Honar, Hooman ; Fu, Alexander Y ; Reineks, Edmunds ; Blood, Jane ; Gibson, David ; Appendix 2. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN Operations Committee ; Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Writing Group, on behalf of The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Investigators ; Vascular events In noncardiac Surgery patIents cOhort evaluatioN VISION Study Investigators ; Appendix 1. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study Investigators Writing Group</creatorcontrib><description>BACKGROUND:Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study’s four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS.
METHODS:In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated “abnormal” laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria.
RESULTS:An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors’ diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96–5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6–41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom.
CONCLUSION:Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.</description><identifier>ISSN: 0003-3022</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/ALN.0000000000000113</identifier><identifier>PMID: 24534856</identifier><identifier>CODEN: ANESAV</identifier><language>eng</language><publisher>Hagerstown, MD: American Society of Anesthesiologists, Inc</publisher><subject>Age Distribution ; Aged ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiology. Vascular system ; Cohort Studies ; Heart ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Ischemia - blood ; Myocardial Ischemia - diagnosis ; Myocardial Ischemia - epidemiology ; Myocarditis. Cardiomyopathies ; Patient Outcome Assessment ; Postoperative Complications - blood ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Prognosis ; Prospective Studies ; Surgical Procedures, Operative ; Troponin T - blood</subject><ispartof>Anesthesiology (Philadelphia), 2014-03, Vol.120 (3), p.564-578</ispartof><rights>2014 American Society of Anesthesiologists, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3827-ec61215a2a774155eedc9b029d98abc9e82398acb2be7d6b4b38496aeb7597a23</citedby><cites>FETCH-LOGICAL-c3827-ec61215a2a774155eedc9b029d98abc9e82398acb2be7d6b4b38496aeb7597a23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28344561$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24534856$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Villar, Juan Carlos</creatorcontrib><creatorcontrib>Xavier, Denis</creatorcontrib><creatorcontrib>Guyatt, Gordon</creatorcontrib><creatorcontrib>Cruz, Patricia</creatorcontrib><creatorcontrib>Berwanger, Otavio</creatorcontrib><creatorcontrib>Biccard, Bruce M</creatorcontrib><creatorcontrib>Malaga, German</creatorcontrib><creatorcontrib>Sessler, Daniel I</creatorcontrib><creatorcontrib>Ackland, Gareth L</creatorcontrib><creatorcontrib>Pettit, Shirley</creatorcontrib><creatorcontrib>Walsh, Michael</creatorcontrib><creatorcontrib>Thomas, Sabu</creatorcontrib><creatorcontrib>Devereaux, P J</creatorcontrib><creatorcontrib>McQueen, Matthew J</creatorcontrib><creatorcontrib>Chow, Clara K</creatorcontrib><creatorcontrib>Mooney, John</creatorcontrib><creatorcontrib>Santucci, Eliana</creatorcontrib><creatorcontrib>Santo, Jose Amalth do Espirirto</creatorcontrib><creatorcontrib>McAlister, Finlay</creatorcontrib><creatorcontrib>McMurtry, Sean</creatorcontrib><creatorcontrib>Bessissow, Amal</creatorcontrib><creatorcontrib>Eikelboom, John</creatorcontrib><creatorcontrib>Ganame, Javier</creatorcontrib><creatorcontrib>Hankinson, James</creatorcontrib><creatorcontrib>Jolly, Sanjit</creatorcontrib><creatorcontrib>Kearon, Clive</creatorcontrib><creatorcontrib>Mizera, Richard</creatorcontrib><creatorcontrib>O’Donnell, Martin</creatorcontrib><creatorcontrib>Pinthus, Jehonathan</creatorcontrib><creatorcontrib>Simunovic, Marko</creatorcontrib><creatorcontrib>Tandon, Vikas</creatorcontrib><creatorcontrib>Patel, Ameen</creatorcontrib><creatorcontrib>Raymer, Karen</creatorcontrib><creatorcontrib>Clase, Catherine</creatorcontrib><creatorcontrib>Jackson, Paul</creatorcontrib><creatorcontrib>Lim, Wendy</creatorcontrib><creatorcontrib>Mazzadi, Sergio</creatorcontrib><creatorcontrib>Garg, Amit</creatorcontrib><creatorcontrib>Lam, Ngan</creatorcontrib><creatorcontrib>Roshanov, Pavel S</creatorcontrib><creatorcontrib>Ramsey, Clare</creatorcontrib><creatorcontrib>McKay, Andrew</creatorcontrib><creatorcontrib>Zacharias, James</creatorcontrib><creatorcontrib>Vásquez, Skarlett</creatorcontrib><creatorcontrib>Castañeda, Alvaro</creatorcontrib><creatorcontrib>Ferreira, Silvia</creatorcontrib><creatorcontrib>Coriat, Pierre</creatorcontrib><creatorcontrib>Goarin, Jean Pierre</creatorcontrib><creatorcontrib>Royer, Catherine</creatorcontrib><creatorcontrib>Daas, Georges</creatorcontrib><creatorcontrib>Choi, Gordon Y S</creatorcontrib><creatorcontrib>Lit, Lydia C W</creatorcontrib><creatorcontrib>Sigamani, Alben</creatorcontrib><creatorcontrib>Cherian, Joseph</creatorcontrib><creatorcontrib>George, Preetha</creatorcontrib><creatorcontrib>Schünemann, Holger</creatorcontrib><creatorcontrib>Vizza, Enrico</creatorcontrib><creatorcontrib>Ong, G. S Y</creatorcontrib><creatorcontrib>Mansor, Marzida</creatorcontrib><creatorcontrib>Rotta-Rotta, Aida</creatorcontrib><creatorcontrib>Musial, Jacek</creatorcontrib><creatorcontrib>Chwala, Maciej</creatorcontrib><creatorcontrib>Cassimjee, Hussein</creatorcontrib><creatorcontrib>Kisten, Theroshnie</creatorcontrib><creatorcontrib>Naidoo, Prebashini</creatorcontrib><creatorcontrib>Naidoo, Rubeshan</creatorcontrib><creatorcontrib>Rodseth, Reitze</creatorcontrib><creatorcontrib>Skinner, David</creatorcontrib><creatorcontrib>Torborg, Alex</creatorcontrib><creatorcontrib>Maestre, Mari Luz</creatorcontrib><creatorcontrib>Santaló, Miquel</creatorcontrib><creatorcontrib>Gonzalez, Raúl</creatorcontrib><creatorcontrib>Pelaez, Xavier</creatorcontrib><creatorcontrib>Varela, Alberto</creatorcontrib><creatorcontrib>de Miguel, Angeles</creatorcontrib><creatorcontrib>Piñeiro, Patricia</creatorcontrib><creatorcontrib>Cusati, Gabriel</creatorcontrib><creatorcontrib>del Barrio, Maria</creatorcontrib><creatorcontrib>Reyes, Fidel</creatorcontrib><creatorcontrib>Sapsford, Robert J</creatorcontrib><creatorcontrib>Barth, Julian</creatorcontrib><creatorcontrib>Scott, Julian</creatorcontrib><creatorcontrib>Hall, Alistair</creatorcontrib><creatorcontrib>Howell, Simon</creatorcontrib><creatorcontrib>Woods, Janet</creatorcontrib><creatorcontrib>Rushton, A</creatorcontrib><creatorcontrib>Khan, Ahsun</creatorcontrib><creatorcontrib>Niebrzegowska, Edyta</creatorcontrib><creatorcontrib>Archbold, Andrew</creatorcontrib><creatorcontrib>McAlees, Eleanor</creatorcontrib><creatorcontrib>Reyes, Anna</creatorcontrib><creatorcontrib>Paredes, Laura Gallego</creatorcontrib><creatorcontrib>Sultan, Pervez</creatorcontrib><creatorcontrib>del Arroyo, Ana Gutierrez</creatorcontrib><creatorcontrib>Egan, Cameron</creatorcontrib><creatorcontrib>Honar, Hooman</creatorcontrib><creatorcontrib>Fu, Alexander Y</creatorcontrib><creatorcontrib>Reineks, Edmunds</creatorcontrib><creatorcontrib>Blood, Jane</creatorcontrib><creatorcontrib>Gibson, David</creatorcontrib><creatorcontrib>Appendix 2. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN Operations Committee</creatorcontrib><creatorcontrib>Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Writing Group, on behalf of The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Investigators</creatorcontrib><creatorcontrib>Vascular events In noncardiac Surgery patIents cOhort evaluatioN VISION Study Investigators</creatorcontrib><creatorcontrib>Appendix 1. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study Investigators Writing Group</creatorcontrib><title>Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>BACKGROUND:Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study’s four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS.
METHODS:In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated “abnormal” laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria.
RESULTS:An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors’ diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96–5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6–41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom.
CONCLUSION:Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.</description><subject>Age Distribution</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cohort Studies</subject><subject>Heart</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Ischemia - blood</subject><subject>Myocardial Ischemia - diagnosis</subject><subject>Myocardial Ischemia - epidemiology</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Patient Outcome Assessment</subject><subject>Postoperative Complications - blood</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Surgical Procedures, Operative</subject><subject>Troponin T - blood</subject><issn>0003-3022</issn><issn>1528-1175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc9u1DAQxi0EokvhDRDyBYnDpvhvnHBbhQKVlhapcI4mjnfXxRsvtkOVp-IVcbQLRfjimfFvvrHmQ-glJReU1Ortan19Qf49lPJHaEElqwpKlXyMFrnIC04YO0PPYrzLqZK8eorOmJBcVLJcoF-fJ68h9BYcvhruxjBh2CQT8LUfjnWNb8ewNWF6h1d4DTlcZjIjAyTrB3BL_CX4eDA62Z8GN37nQ8K3aewnfBkTdM7GnR22-L2F7eBjsho3wWYBC0vc7CCAnpP5Ic5aprc6-ZBjGHrMSdHDhG_GpP3exOfoyQZcNC9O9zn69uHya_OpWN98vGpW60LziqnC6JIyKoGBUoJKaUyv646wuq8r6HRtKsZzpDvWGdWXneh4JeoSTKdkrYDxc_TmqHsI_sdoYmr3NmrjHAzGj7GlkpCyziIqo-KI6ryGGMymPQS7hzC1lLSzVW22qv3fqtz26jRh7Pam_9v0x5sMvD4BEDW4TYBB2_jAVVwIWdKH-ffe5UXG7268N6HdGXBpd5wrBSsYoYLwnBTzBxT_DVKFraU</recordid><startdate>201403</startdate><enddate>201403</enddate><creator>Villar, Juan Carlos</creator><creator>Xavier, Denis</creator><creator>Guyatt, Gordon</creator><creator>Cruz, Patricia</creator><creator>Berwanger, Otavio</creator><creator>Biccard, Bruce M</creator><creator>Malaga, German</creator><creator>Sessler, Daniel I</creator><creator>Ackland, Gareth L</creator><creator>Pettit, Shirley</creator><creator>Walsh, Michael</creator><creator>Thomas, Sabu</creator><creator>Devereaux, P J</creator><creator>McQueen, Matthew J</creator><creator>Chow, Clara K</creator><creator>Mooney, John</creator><creator>Santucci, Eliana</creator><creator>Santo, Jose Amalth do Espirirto</creator><creator>McAlister, Finlay</creator><creator>McMurtry, Sean</creator><creator>Bessissow, Amal</creator><creator>Eikelboom, John</creator><creator>Ganame, Javier</creator><creator>Hankinson, James</creator><creator>Jolly, Sanjit</creator><creator>Kearon, Clive</creator><creator>Mizera, Richard</creator><creator>O’Donnell, Martin</creator><creator>Pinthus, Jehonathan</creator><creator>Simunovic, Marko</creator><creator>Tandon, Vikas</creator><creator>Patel, Ameen</creator><creator>Raymer, Karen</creator><creator>Clase, Catherine</creator><creator>Jackson, Paul</creator><creator>Lim, Wendy</creator><creator>Mazzadi, Sergio</creator><creator>Garg, Amit</creator><creator>Lam, Ngan</creator><creator>Roshanov, Pavel S</creator><creator>Ramsey, Clare</creator><creator>McKay, Andrew</creator><creator>Zacharias, James</creator><creator>Vásquez, Skarlett</creator><creator>Castañeda, Alvaro</creator><creator>Ferreira, Silvia</creator><creator>Coriat, Pierre</creator><creator>Goarin, Jean Pierre</creator><creator>Royer, Catherine</creator><creator>Daas, Georges</creator><creator>Choi, Gordon Y S</creator><creator>Lit, Lydia C W</creator><creator>Sigamani, Alben</creator><creator>Cherian, Joseph</creator><creator>George, Preetha</creator><creator>Schünemann, Holger</creator><creator>Vizza, Enrico</creator><creator>Ong, G. S Y</creator><creator>Mansor, Marzida</creator><creator>Rotta-Rotta, Aida</creator><creator>Musial, Jacek</creator><creator>Chwala, Maciej</creator><creator>Cassimjee, Hussein</creator><creator>Kisten, Theroshnie</creator><creator>Naidoo, Prebashini</creator><creator>Naidoo, Rubeshan</creator><creator>Rodseth, Reitze</creator><creator>Skinner, David</creator><creator>Torborg, Alex</creator><creator>Maestre, Mari Luz</creator><creator>Santaló, Miquel</creator><creator>Gonzalez, Raúl</creator><creator>Pelaez, Xavier</creator><creator>Varela, Alberto</creator><creator>de Miguel, Angeles</creator><creator>Piñeiro, Patricia</creator><creator>Cusati, Gabriel</creator><creator>del Barrio, Maria</creator><creator>Reyes, Fidel</creator><creator>Sapsford, Robert J</creator><creator>Barth, Julian</creator><creator>Scott, Julian</creator><creator>Hall, Alistair</creator><creator>Howell, Simon</creator><creator>Woods, Janet</creator><creator>Rushton, A</creator><creator>Khan, Ahsun</creator><creator>Niebrzegowska, Edyta</creator><creator>Archbold, Andrew</creator><creator>McAlees, Eleanor</creator><creator>Reyes, Anna</creator><creator>Paredes, Laura Gallego</creator><creator>Sultan, Pervez</creator><creator>del Arroyo, Ana Gutierrez</creator><creator>Egan, Cameron</creator><creator>Honar, Hooman</creator><creator>Fu, Alexander Y</creator><creator>Reineks, Edmunds</creator><creator>Blood, Jane</creator><creator>Gibson, David</creator><general>American Society of Anesthesiologists, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201403</creationdate><title>Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes</title><author>Villar, Juan Carlos ; Xavier, Denis ; Guyatt, Gordon ; Cruz, Patricia ; Berwanger, Otavio ; Biccard, Bruce M ; Malaga, German ; Sessler, Daniel I ; Ackland, Gareth L ; Pettit, Shirley ; Walsh, Michael ; Thomas, Sabu ; Devereaux, P J ; McQueen, Matthew J ; Chow, Clara K ; Mooney, John ; Santucci, Eliana ; Santo, Jose Amalth do Espirirto ; McAlister, Finlay ; McMurtry, Sean ; Bessissow, Amal ; Eikelboom, John ; Ganame, Javier ; Hankinson, James ; Jolly, Sanjit ; Kearon, Clive ; Mizera, Richard ; O’Donnell, Martin ; Pinthus, Jehonathan ; Simunovic, Marko ; Tandon, Vikas ; Patel, Ameen ; Raymer, Karen ; Clase, Catherine ; Jackson, Paul ; Lim, Wendy ; Mazzadi, Sergio ; Garg, Amit ; Lam, Ngan ; Roshanov, Pavel S ; Ramsey, Clare ; McKay, Andrew ; Zacharias, James ; Vásquez, Skarlett ; Castañeda, Alvaro ; Ferreira, Silvia ; Coriat, Pierre ; Goarin, Jean Pierre ; Royer, Catherine ; Daas, Georges ; Choi, Gordon Y S ; Lit, Lydia C W ; Sigamani, Alben ; Cherian, Joseph ; George, Preetha ; Schünemann, Holger ; Vizza, Enrico ; Ong, G. S Y ; Mansor, Marzida ; Rotta-Rotta, Aida ; Musial, Jacek ; Chwala, Maciej ; Cassimjee, Hussein ; Kisten, Theroshnie ; Naidoo, Prebashini ; Naidoo, Rubeshan ; Rodseth, Reitze ; Skinner, David ; Torborg, Alex ; Maestre, Mari Luz ; Santaló, Miquel ; Gonzalez, Raúl ; Pelaez, Xavier ; Varela, Alberto ; de Miguel, Angeles ; Piñeiro, Patricia ; Cusati, Gabriel ; del Barrio, Maria ; Reyes, Fidel ; Sapsford, Robert J ; Barth, Julian ; Scott, Julian ; Hall, Alistair ; Howell, Simon ; Woods, Janet ; Rushton, A ; Khan, Ahsun ; Niebrzegowska, Edyta ; Archbold, Andrew ; McAlees, Eleanor ; Reyes, Anna ; Paredes, Laura Gallego ; Sultan, Pervez ; del Arroyo, Ana Gutierrez ; Egan, Cameron ; Honar, Hooman ; Fu, Alexander Y ; Reineks, Edmunds ; Blood, Jane ; Gibson, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3827-ec61215a2a774155eedc9b029d98abc9e82398acb2be7d6b4b38496aeb7597a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Age Distribution</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cohort Studies</topic><topic>Heart</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Ischemia - blood</topic><topic>Myocardial Ischemia - diagnosis</topic><topic>Myocardial Ischemia - epidemiology</topic><topic>Myocarditis. Cardiomyopathies</topic><topic>Patient Outcome Assessment</topic><topic>Postoperative Complications - blood</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Surgical Procedures, Operative</topic><topic>Troponin T - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Villar, Juan Carlos</creatorcontrib><creatorcontrib>Xavier, Denis</creatorcontrib><creatorcontrib>Guyatt, Gordon</creatorcontrib><creatorcontrib>Cruz, Patricia</creatorcontrib><creatorcontrib>Berwanger, Otavio</creatorcontrib><creatorcontrib>Biccard, Bruce M</creatorcontrib><creatorcontrib>Malaga, German</creatorcontrib><creatorcontrib>Sessler, Daniel I</creatorcontrib><creatorcontrib>Ackland, Gareth L</creatorcontrib><creatorcontrib>Pettit, Shirley</creatorcontrib><creatorcontrib>Walsh, Michael</creatorcontrib><creatorcontrib>Thomas, Sabu</creatorcontrib><creatorcontrib>Devereaux, P J</creatorcontrib><creatorcontrib>McQueen, Matthew J</creatorcontrib><creatorcontrib>Chow, Clara K</creatorcontrib><creatorcontrib>Mooney, John</creatorcontrib><creatorcontrib>Santucci, Eliana</creatorcontrib><creatorcontrib>Santo, Jose Amalth do Espirirto</creatorcontrib><creatorcontrib>McAlister, Finlay</creatorcontrib><creatorcontrib>McMurtry, Sean</creatorcontrib><creatorcontrib>Bessissow, Amal</creatorcontrib><creatorcontrib>Eikelboom, John</creatorcontrib><creatorcontrib>Ganame, Javier</creatorcontrib><creatorcontrib>Hankinson, James</creatorcontrib><creatorcontrib>Jolly, Sanjit</creatorcontrib><creatorcontrib>Kearon, Clive</creatorcontrib><creatorcontrib>Mizera, Richard</creatorcontrib><creatorcontrib>O’Donnell, Martin</creatorcontrib><creatorcontrib>Pinthus, Jehonathan</creatorcontrib><creatorcontrib>Simunovic, Marko</creatorcontrib><creatorcontrib>Tandon, Vikas</creatorcontrib><creatorcontrib>Patel, Ameen</creatorcontrib><creatorcontrib>Raymer, Karen</creatorcontrib><creatorcontrib>Clase, Catherine</creatorcontrib><creatorcontrib>Jackson, Paul</creatorcontrib><creatorcontrib>Lim, Wendy</creatorcontrib><creatorcontrib>Mazzadi, Sergio</creatorcontrib><creatorcontrib>Garg, Amit</creatorcontrib><creatorcontrib>Lam, Ngan</creatorcontrib><creatorcontrib>Roshanov, Pavel S</creatorcontrib><creatorcontrib>Ramsey, Clare</creatorcontrib><creatorcontrib>McKay, Andrew</creatorcontrib><creatorcontrib>Zacharias, James</creatorcontrib><creatorcontrib>Vásquez, Skarlett</creatorcontrib><creatorcontrib>Castañeda, Alvaro</creatorcontrib><creatorcontrib>Ferreira, Silvia</creatorcontrib><creatorcontrib>Coriat, Pierre</creatorcontrib><creatorcontrib>Goarin, Jean Pierre</creatorcontrib><creatorcontrib>Royer, Catherine</creatorcontrib><creatorcontrib>Daas, Georges</creatorcontrib><creatorcontrib>Choi, Gordon Y S</creatorcontrib><creatorcontrib>Lit, Lydia C W</creatorcontrib><creatorcontrib>Sigamani, Alben</creatorcontrib><creatorcontrib>Cherian, Joseph</creatorcontrib><creatorcontrib>George, Preetha</creatorcontrib><creatorcontrib>Schünemann, Holger</creatorcontrib><creatorcontrib>Vizza, Enrico</creatorcontrib><creatorcontrib>Ong, G. S Y</creatorcontrib><creatorcontrib>Mansor, Marzida</creatorcontrib><creatorcontrib>Rotta-Rotta, Aida</creatorcontrib><creatorcontrib>Musial, Jacek</creatorcontrib><creatorcontrib>Chwala, Maciej</creatorcontrib><creatorcontrib>Cassimjee, Hussein</creatorcontrib><creatorcontrib>Kisten, Theroshnie</creatorcontrib><creatorcontrib>Naidoo, Prebashini</creatorcontrib><creatorcontrib>Naidoo, Rubeshan</creatorcontrib><creatorcontrib>Rodseth, Reitze</creatorcontrib><creatorcontrib>Skinner, David</creatorcontrib><creatorcontrib>Torborg, Alex</creatorcontrib><creatorcontrib>Maestre, Mari Luz</creatorcontrib><creatorcontrib>Santaló, Miquel</creatorcontrib><creatorcontrib>Gonzalez, Raúl</creatorcontrib><creatorcontrib>Pelaez, Xavier</creatorcontrib><creatorcontrib>Varela, Alberto</creatorcontrib><creatorcontrib>de Miguel, Angeles</creatorcontrib><creatorcontrib>Piñeiro, Patricia</creatorcontrib><creatorcontrib>Cusati, Gabriel</creatorcontrib><creatorcontrib>del Barrio, Maria</creatorcontrib><creatorcontrib>Reyes, Fidel</creatorcontrib><creatorcontrib>Sapsford, Robert J</creatorcontrib><creatorcontrib>Barth, Julian</creatorcontrib><creatorcontrib>Scott, Julian</creatorcontrib><creatorcontrib>Hall, Alistair</creatorcontrib><creatorcontrib>Howell, Simon</creatorcontrib><creatorcontrib>Woods, Janet</creatorcontrib><creatorcontrib>Rushton, A</creatorcontrib><creatorcontrib>Khan, Ahsun</creatorcontrib><creatorcontrib>Niebrzegowska, Edyta</creatorcontrib><creatorcontrib>Archbold, Andrew</creatorcontrib><creatorcontrib>McAlees, Eleanor</creatorcontrib><creatorcontrib>Reyes, Anna</creatorcontrib><creatorcontrib>Paredes, Laura Gallego</creatorcontrib><creatorcontrib>Sultan, Pervez</creatorcontrib><creatorcontrib>del Arroyo, Ana Gutierrez</creatorcontrib><creatorcontrib>Egan, Cameron</creatorcontrib><creatorcontrib>Honar, Hooman</creatorcontrib><creatorcontrib>Fu, Alexander Y</creatorcontrib><creatorcontrib>Reineks, Edmunds</creatorcontrib><creatorcontrib>Blood, Jane</creatorcontrib><creatorcontrib>Gibson, David</creatorcontrib><creatorcontrib>Appendix 2. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN Operations Committee</creatorcontrib><creatorcontrib>Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Writing Group, on behalf of The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Investigators</creatorcontrib><creatorcontrib>Vascular events In noncardiac Surgery patIents cOhort evaluatioN VISION Study Investigators</creatorcontrib><creatorcontrib>Appendix 1. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study Investigators Writing Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Villar, Juan Carlos</au><au>Xavier, Denis</au><au>Guyatt, Gordon</au><au>Cruz, Patricia</au><au>Berwanger, Otavio</au><au>Biccard, Bruce M</au><au>Malaga, German</au><au>Sessler, Daniel I</au><au>Ackland, Gareth L</au><au>Pettit, Shirley</au><au>Walsh, Michael</au><au>Thomas, Sabu</au><au>Devereaux, P J</au><au>McQueen, Matthew J</au><au>Chow, Clara K</au><au>Mooney, John</au><au>Santucci, Eliana</au><au>Santo, Jose Amalth do Espirirto</au><au>McAlister, Finlay</au><au>McMurtry, Sean</au><au>Bessissow, Amal</au><au>Eikelboom, John</au><au>Ganame, Javier</au><au>Hankinson, James</au><au>Jolly, Sanjit</au><au>Kearon, Clive</au><au>Mizera, Richard</au><au>O’Donnell, Martin</au><au>Pinthus, Jehonathan</au><au>Simunovic, Marko</au><au>Tandon, Vikas</au><au>Patel, Ameen</au><au>Raymer, Karen</au><au>Clase, Catherine</au><au>Jackson, Paul</au><au>Lim, Wendy</au><au>Mazzadi, Sergio</au><au>Garg, Amit</au><au>Lam, Ngan</au><au>Roshanov, Pavel S</au><au>Ramsey, Clare</au><au>McKay, Andrew</au><au>Zacharias, James</au><au>Vásquez, Skarlett</au><au>Castañeda, Alvaro</au><au>Ferreira, Silvia</au><au>Coriat, Pierre</au><au>Goarin, Jean Pierre</au><au>Royer, Catherine</au><au>Daas, Georges</au><au>Choi, Gordon Y S</au><au>Lit, Lydia C W</au><au>Sigamani, Alben</au><au>Cherian, Joseph</au><au>George, Preetha</au><au>Schünemann, Holger</au><au>Vizza, Enrico</au><au>Ong, G. S Y</au><au>Mansor, Marzida</au><au>Rotta-Rotta, Aida</au><au>Musial, Jacek</au><au>Chwala, Maciej</au><au>Cassimjee, Hussein</au><au>Kisten, Theroshnie</au><au>Naidoo, Prebashini</au><au>Naidoo, Rubeshan</au><au>Rodseth, Reitze</au><au>Skinner, David</au><au>Torborg, Alex</au><au>Maestre, Mari Luz</au><au>Santaló, Miquel</au><au>Gonzalez, Raúl</au><au>Pelaez, Xavier</au><au>Varela, Alberto</au><au>de Miguel, Angeles</au><au>Piñeiro, Patricia</au><au>Cusati, Gabriel</au><au>del Barrio, Maria</au><au>Reyes, Fidel</au><au>Sapsford, Robert J</au><au>Barth, Julian</au><au>Scott, Julian</au><au>Hall, Alistair</au><au>Howell, Simon</au><au>Woods, Janet</au><au>Rushton, A</au><au>Khan, Ahsun</au><au>Niebrzegowska, Edyta</au><au>Archbold, Andrew</au><au>McAlees, Eleanor</au><au>Reyes, Anna</au><au>Paredes, Laura Gallego</au><au>Sultan, Pervez</au><au>del Arroyo, Ana Gutierrez</au><au>Egan, Cameron</au><au>Honar, Hooman</au><au>Fu, Alexander Y</au><au>Reineks, Edmunds</au><au>Blood, Jane</au><au>Gibson, David</au><aucorp>Appendix 2. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN Operations Committee</aucorp><aucorp>Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Writing Group, on behalf of The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Investigators</aucorp><aucorp>Vascular events In noncardiac Surgery patIents cOhort evaluatioN VISION Study Investigators</aucorp><aucorp>Appendix 1. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study Investigators Writing Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes</atitle><jtitle>Anesthesiology (Philadelphia)</jtitle><addtitle>Anesthesiology</addtitle><date>2014-03</date><risdate>2014</risdate><volume>120</volume><issue>3</issue><spage>564</spage><epage>578</epage><pages>564-578</pages><issn>0003-3022</issn><eissn>1528-1175</eissn><coden>ANESAV</coden><abstract>BACKGROUND:Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study’s four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS.
METHODS:In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated “abnormal” laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria.
RESULTS:An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors’ diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96–5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6–41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom.
CONCLUSION:Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.</abstract><cop>Hagerstown, MD</cop><pub>American Society of Anesthesiologists, Inc</pub><pmid>24534856</pmid><doi>10.1097/ALN.0000000000000113</doi><tpages>15</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0003-3022 |
| ispartof | Anesthesiology (Philadelphia), 2014-03, Vol.120 (3), p.564-578 |
| issn | 0003-3022 1528-1175 |
| language | eng |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Age Distribution Aged Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiology. Vascular system Cohort Studies Heart Humans Male Medical sciences Middle Aged Myocardial Ischemia - blood Myocardial Ischemia - diagnosis Myocardial Ischemia - epidemiology Myocarditis. Cardiomyopathies Patient Outcome Assessment Postoperative Complications - blood Postoperative Complications - diagnosis Postoperative Complications - epidemiology Prognosis Prospective Studies Surgical Procedures, Operative Troponin T - blood |
| title | Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes |
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