Thomas, Sabu and Borges, Flavia and Bhandari, Mohit and De Beer, Justin and Urrútia Cuchí, Gerard and Adili, Anthony and Winemaker, Mitchell and Avram, Victoria and Chan, Matthew T.V. and Lamas, Claudia and Cruz, Patricia and Aguilera, Xavier and Garutti, Ignacio and Alonso-Coello, Pablo and Villar, Juan Carlos and Jacka, Michael and Wang, C.Y. and Berwanger, Otavio and Chow, Clara and Srinathan, Sadeesh and Pettit, Shirley and Heels-Ansdell, Dianne and Rubery, Paul and Devereaux, P.J. and Thomas, Sabu and Walsh, Michael and Tiboni, Maria and Guyatt, Gordon and Heels-Ansdell, Diane and Thorlund, Kristian and Thabane, Lehana and Bhandari, Mohit and Bosch, Jackie and Chan, Matthew T.V. and Shatin, NT and Alonso-Coello, Pablo and Berwanger, Otavio and Carlos Villar, Juan and Wang, Chew Yin and Garutti, R. Ignacio and Jacka, Michael J. and Sigamani, Alben and Srinathan, Sadeesh and Biccard, Bruce M. and Rodseth, Reitze N. and Chow, Clara K. and Abraham, Valsa and Pettit, Shirley and McQueen, Matthew J. and VanHelder, Tomas and Szczeklik, Wojciech and Buse, Giovanna Lurati and Botto, Fernando and Yusuf, Salim and Sessler, Daniel I. and Kurz, Andrea and Garg, Amit X. and Mrkobrada, Marko and Pearse, Rupert M. and Polanczyk, Carisi A. and Malaga, German and Nagele, Peter and Le Manach, Yannick and Leuwer, Martin and Devereaux, P.J. (2020) Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery. The Journal of Bone and Joint Surgery, 102 (10). pp. 880-888. ISSN 0021-9355, DOI https://doi.org/10.2106/JBJS.18.01305.
Full text not available from this repository.Abstract
BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is common and of prognostic importance. Little is known about MINS in orthopaedic surgery. The diagnostic criterion for MINS was a level of ≥0.03 ng/mL on a non-high-sensitivity troponin T (TnT) assay due to myocardial ischemia. METHODS: We undertook an international, prospective study of 15,103 patients ≥45 years of age who had inpatient noncardiac surgery; 3,092 underwent orthopaedic surgery. Non-high-sensitivity TnT assays were performed on postoperative days 0, 1, 2, and 3. Among orthopaedic patients, we determined (1) the prognostic relevance of the MINS diagnostic criteria, (2) the 30-day mortality rate for those with and without MINS, and (3) the probable proportion of MINS cases that would go undetected without troponin monitoring because of a lack of an ischemic symptom. RESULTS: Three hundred and sixty-seven orthopaedic patients (11.9%) had MINS. MINS was associated independently with 30-day mortality including among those who had had orthopaedic surgery. Orthopaedic patients without and with MINS had a 30-day mortality rate of 1.0% and 9.8%, respectively (odds ratio [OR], 11.28; 95% confidence interval [CI], 6.72 to 18.92). The 30-day mortality rate was increased for patients with MINS who had an ischemic feature (i.e., symptoms, or evidence of ischemia on electrocardiography or imaging) (OR, 18.25; 95% CI, 10.06 to 33.10) and for those who did not have an ischemic feature (OR, 7.35; 95% CI, 3.37 to 16.01). The proportion of orthopaedic patients with MINS who were asymptomatic and in whom the myocardial injury would have probably gone undetected without TnT monitoring was 81.3% (95% CI, 76.3% to 85.4%). CONCLUSIONS: One in 8 orthopaedic patients in our study had MINS, and MINS was associated with a higher mortality rate regardless of symptoms. Troponin levels should be measured after surgery in at-risk patients because most MINS cases (>80%) are asymptomatic and would go undetected without routine measurements. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
| Item Type: | Article |
|---|---|
| Funders: | UNSPECIFIED |
| Uncontrolled Keywords: | General Surgery; Patients; Undergoing noncardiac |
| Subjects: | R Medicine |
| Divisions: | Faculty of Medicine |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 15 Jun 2020 01:16 |
| Last Modified: | 15 Jun 2020 01:16 |
| URI: | http://eprints.um.edu.my/id/eprint/24810 |
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