Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery: A Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Substudy
Publication in refereed journal

香港中文大學研究人員
替代計量分析
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其它資訊
摘要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.
著者Thomas S, Borges F, Bhandari M, De Beer J, Urrútia Cuchí G, Adili A, Winemaker M, Avram V, Chan MTV, Lamas C, Cruz P, Aguilera X, Garutti I, Alonso-Coello P, Villar JC, Jacka M, Wang CY, Berwanger O, Chow C, Srinathan S, Pettit S, Heels-Ansdell D, Rubery P, Devereaux PJ; on behalf of the VISION Investigators
期刊名稱Journal of Bone and Joint Surgery
出版年份2020
月份5
日期20
卷號102
期次10
出版社Lippincott, Williams & Wilkins
頁次880 - 888
國際標準期刊號0021-9355
語言英式英語

上次更新時間 2020-18-09 於 00:24