Myocardial Injury After Noncardiac Surgery (MINS) in Vascular Surgical Patients: A Prospective Observational Cohort Study

Chan, M.T.V.; Szalay, D.; Abraham, V.; Szczeklik, W.; Sigamani, A.; Le Mananch, Y.; Cruz, P.; Srinathan, S.K.; Harlock, J.; Jacka, M.J.; Williams, C.; Rapanos, T.; Heels-Ansdell, D.M.; Archbold, A.; Cortés, O.L.; Málaga Rodríguez, Germán Javier; Chow, C.K.; Montes, F.R.; Urrútia, G.; Berwanger, O.; Tittley, J.G.; Wang, C.-Y.; Devereaux, P.J.; Sapsford, R.J.; Biccard, B.M.; Dubois, L.; Scott, D.J.A.; Elias, F.; Ackland, G.L.; Hutcherson, M.T.; Polanczyk, C.A.

dc.contributor.author	Biccard, B.M.
dc.contributor.author	Scott, D.J.A.
dc.contributor.author	Chan, M.T.V.
dc.contributor.author	Archbold, A.
dc.contributor.author	Wang, C.-Y.
dc.contributor.author	Sigamani, A.
dc.contributor.author	Urrútia, G.
dc.contributor.author	Cruz, P.
dc.contributor.author	Srinathan, S.K.
dc.contributor.author	Szalay, D.
dc.contributor.author	Harlock, J.
dc.contributor.author	Tittley, J.G.
dc.contributor.author	Rapanos, T.
dc.contributor.author	Elias, F.
dc.contributor.author	Jacka, M.J.
dc.contributor.author	Málaga Rodríguez, Germán Javier
dc.contributor.author	Abraham, V.
dc.contributor.author	Berwanger, O.
dc.contributor.author	Montes, F.R.
dc.contributor.author	Heels-Ansdell, D.M.
dc.contributor.author	Hutcherson, M.T.
dc.contributor.author	Chow, C.K.
dc.contributor.author	Polanczyk, C.A.
dc.contributor.author	Szczeklik, W.
dc.contributor.author	Ackland, G.L.
dc.contributor.author	Dubois, L.
dc.contributor.author	Sapsford, R.J.
dc.contributor.author	Williams, C.
dc.contributor.author	Cortés, O.L.
dc.contributor.author	Le Mananch, Y.
dc.contributor.author	Devereaux, P.J.
dc.date.accessioned	2019-04-24T18:23:51Z
dc.date.available	2019-04-24T18:23:51Z
dc.date.issued	2018
dc.identifier.uri	https://hdl.handle.net/20.500.12866/6459
dc.description.abstract	Objective: To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients. Background: MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described. Methods: This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery. All patients had fourth-generation plasma troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a TnT of 0.03 ng/mL of higher secondary to ischemia. The objectives of the present study were to determine (i) if MINS is prognostically important in vascular surgical patients, (ii) the clinical characteristics of vascular surgery patients with and without MINS, (iii) the 30-day outcomes for vascular surgery patients with and without MINS, and (iv) the proportion of MINS that probably would have gone undetected without routine troponin monitoring. Results: The incidence of MINS in the vascular surgery patients was 19.1% (95% confidence interval (CI), 15.7%-22.6%). 30-day all-cause mortality in the vascular cohort was 12.5% (95% CI 7.3%-20.6%) in patients with MINS compared with 1.5% (95% CI 0.7%-3.2%) in patients without MINS (P < 0.001). MINS was independently associated with 30-day mortality in vascular patients (odds ratio, 9.48; 95% CI, 3.46-25.96). The 30-day mortality was similar in MINS patients with (15.0%; 95% CI, 7.1-29.1) and without an ischemic feature (12.2%; 95% CI, 5.3-25.5, P = 0.76). The proportion of vascular surgery patients who suffered MINS without overt evidence of myocardial ischemia was 74.1% (95% CI, 63.6-82.4). Conclusions: Approximately 1 in 5 patients experienced MINS after vascular surgery. MINS was independently associated with 30-day mortality. The majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.	en_US
dc.language.iso	eng
dc.publisher	Wolters Kluwer Health
dc.relation.ispartofseries	Annals of Surgery
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	troponin T	en_US
dc.subject	adult	en_US
dc.subject	aged	en_US
dc.subject	all cause mortality	en_US
dc.subject	artery reconstruction	en_US
dc.subject	Article	en_US
dc.subject	atrial fibrillation	en_US
dc.subject	cardiac imaging	en_US
dc.subject	cerebrovascular surgery	en_US
dc.subject	clinical outcome	en_US
dc.subject	cohort analysis	en_US
dc.subject	congestive heart failure	en_US
dc.subject	coronary artery bypass graft	en_US
dc.subject	coronary artery disease	en_US
dc.subject	electrocardiogram	en_US
dc.subject	endovascular aneurysm repair	en_US
dc.subject	female	en_US
dc.subject	health care personnel	en_US
dc.subject	heart arrest	en_US
dc.subject	heart muscle injury	en_US
dc.subject	heart muscle revascularization	en_US
dc.subject	human	en_US
dc.subject	kidney dysfunction	en_US
dc.subject	length of stay	en_US
dc.subject	major clinical study	en_US
dc.subject	male	en_US
dc.subject	middle aged	en_US
dc.subject	observational study	en_US
dc.subject	percutaneous coronary intervention	en_US
dc.subject	postoperative complication	en_US
dc.subject	postoperative period	en_US
dc.subject	priority journal	en_US
dc.subject	prognosis	en_US
dc.subject	prospective study	en_US
dc.subject	Q wave	en_US
dc.subject	scintiscanning	en_US
dc.subject	ST segment depression	en_US
dc.subject	ST segment elevation	en_US
dc.subject	surgical mortality	en_US
dc.subject	surgical patient	en_US
dc.subject	T wave inversion	en_US
dc.subject	vascular surgery	en_US
dc.title	Myocardial Injury After Noncardiac Surgery (MINS) in Vascular Surgical Patients: A Prospective Observational Cohort Study	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1097/SLA.0000000000002290
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.11
dc.relation.issn	1528-1140