Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes.
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Botto Fernando, Alonso-Coello Pablo, Chan Matthew T V, Villar Juan Carlos, Xavier Denis, Srinathan Sadeesh, Guyatt Gordon, Cruz Patricia, Graham Michelle, Wang C Y, Berwanger Otavio, Pearse Rupert M, Biccard Bruce M, Abraham Valsa, Malaga German, Hillis Graham S, Rodseth Reitze N, Cook Deborah, Polanczyk Carisi A, Szczeklik Wojciech, Sessler Daniel I, Sheth Tej, Ackland Gareth L, Leuwer Martin, Garg Amit X, Lemanach Yannick, Pettit Shirley, Heels-Ansdell Diane, Luratibuse Giovanna, Walsh Michael, Sapsford Robert, Schünemann Holger J, Kurz Andrea, Thomas Sabu, Mrkobrada Marko, Thabane Lehana, Gerstein Hertzel, Paniagua Pilar, Nagele Peter, Raina Parminder, Yusuf Salim, Devereaux P J, Devereaux P J, Sessler Daniel I, Walsh Michael, Guyatt Gordon, McQueen Matthew J, Bhandari Mohit, Cook Deborah, Bosch Jackie, Buckley Norman, Yusuf Salim, Chow Clara K, Hillis Graham S, Halliwell Richard, Li Stephen, Lee Vincent W, Mooney John, Polanczyk Carisi A, Furtado Mariana V, Berwanger Otavio, Suzumura Erica, Santucci Eliana, Leite Katia, Santo Jose Amalth do Espirirto, Jardim Cesar A P, Cavalcanti Alexandre Biasi, Guimaraes Helio Penna, Jacka Michael J, Graham Michelle, McAlister Finlay, McMurtry Sean, Townsend Derek, Pannu Neesh, Bagshaw Sean, Bessissow Amal, Bhandari Mohit, Duceppe Emmanuelle, Eikelboom John, Ganame Javier, Hankinson James, Hill Stephen, Jolly Sanjit, Lamy Andre, Ling Elizabeth, Magloire Patrick, Pare Guillaume, Reddy Deven, Szalay David, Tittley Jacques, Weitz Jeff, Whitlock Richard, Darvish-Kazim Saeed, Debeer Justin, Kavsak Peter, Kearon Clive, Mizera Richard, O'Donnell Martin, McQueen Matthew, Pinthus Jehonathan, Ribas Sebastian, Simunovic Marko, Tandon Vikas, Vanhelder Tomas, Winemaker Mitchell, Gerstein Hertzel, McDonald Sarah, O'Bryne Paul, Patel Ameen, Paul James, Punthakee Zubin, Raymer Karen, Salehian Omid, Spencer Fred, Walter Stephen, Worster Andrew, Adili Anthony, Clase Catherine, Cook Deborah, Crowther Mark, Douketis James, Gangji Azim, Jackson Paul, Lim Wendy, Lovrics Peter, Mazzadi Sergio, Orovan William, Rudkowski Jill, Soth Mark, Tiboni Maria, Acedillo Rey, Garg Amit, Hildebrand Ainslie, Lam Ngan, Macneil Danielle, Mrkobrada Marko, Roshanov Pavel S, Srinathan Sadeesh K, Ramsey Clare, John Philip St, Thorlacius Laurel, Siddiqui Faisal S, Grocott Hilary P, McKay Andrew, Lee Trevor W R, Amadeo Ryan, Funk Duane, McDonald Heather, Zacharias James, Villar Juan Carlos, Cortés Olga Lucía, Chaparro Maria Stella, Vásquez Skarlett, Castañeda Alvaro, Ferreira Silvia, Coriat Pierre, Monneret Denis, Goarin Jean Pierre, Esteve Cristina Ibanez, Royer Catherine, Daas Georges, Chan Matthew T V, Choi Gordon Y S, Gin Tony, Lit Lydia C W, Xavier Denis, Sigamani Alben, Faruqui Atiya, Dhanpal Radhika, Almeida Smitha, Cherian Joseph, Furruqh Sultana, Abraham Valsa, Afzal Lalita, George Preetha, Mala Shaveta, Schünemann Holger, Muti Paola, Vizza Enrico, Wang C Y, Ong G S Y, Mansor Marzida, Tan Alvin S B, Shariffuddin Ina I, Vasanthan V, Hashim N H M, Undok A Wahab, Ki Ushananthini, Lai Hou Yee, Ahmad Wan Azman, Razack Azad H A, Malaga German, Valderrama-Victoria Vanessa, Loza-Herrera Javier D, De Los Angeles Lazo Maria, Rotta-Rotta Aida, Szczeklik Wojciech, Sokolowska Barbara, Musial Jacek, Gorka Jacek, Iwaszczuk Pawel, Kozka Mateusz, Chwala Maciej, Raczek Marcin, Mrowiecki Tomasz, Kaczmarek Bogusz, Biccard Bruce, Cassimjee Hussein, Gopalan Dean, Kisten Theroshnie, Mugabi Aine, Naidoo Prebashini, Naidoo Rubeshan, Rodseth Reitze, Skinner David, Torborg Alex, Paniagua Pilar, Urrutia Gerard, Maestre Mari Luz, Santaló Miquel, Gonzalez Raúl, Font Adrià, Martínez Cecilia, Pelaez Xavier, De Antonio Marta, Villamor Jose Marcial, García Jesús Alvarez, Ferré Maria José, Popova Ekaterina, Alonso-Coello Pablo, Garutti Ignacio, Cruz Patricia, Fernández Carmen, Palencia Maria, Díaz Susana, Del Castillo Teresa, Varela Alberto, de Miguel Angeles, Muñoz Manuel, Piñeiro Patricia, Cusati Gabriel, Del Barrio Maria, Membrillo Maria José, Orozco David, Reyes Fidel, Sapsford Robert J, Barth Julian, Scott Julian, Hall Alistair, Howell Simon, Lobley Michaela, Woods Janet, Howard Susannah, Fletcher Joanne, Dewhirst Nikki, Williams C, Rushton A, Welters I, Leuwer M, Pearse Rupert, Ackland Gareth, Khan Ahsun, Niebrzegowska Edyta, Benton Sally, Wragg Andrew, Archbold Andrew, Smith Amanda, McAlees Eleanor, Ramballi Cheryl, Macdonald Neil, Januszewska Marta, Stephens Robert, Reyes Anna, Paredes Laura Gallego, Sultan Pervez, Cain David, Whittle John, Del Arroyo Ana Gutierrez, Sessler Daniel I, Kurz Andrea, Sun Zhuo, Finnegan Patrick S, Egan Cameron, Honar Hooman, Shahinyan Aram, Panjasawatwong Krit, Fu Alexander Y, Wang Sihe, Reineks Edmunds, Nagele Peter, Blood Jane, Kalin Megan, Gibson David, Wildes Troy, 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, Appendix 1. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Study Investigators Writing Group, Appendix 2. The Vascular events In noncardiac Surgery patIents cOhort evaluatioN Operations Committee, Vascular events In noncardiac Surgery patIents cOhort evaluatioN VISION Study Investigators
Аннотация
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.