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.
| Original language | English |
|---|---|
| Pages (from-to) | 564-578 |
| Number of pages | 15 |
| Journal | Anesthesiology |
| Volume | 120 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2014 |
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine
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Myocardial Injury after Noncardiac Surgery : A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes. / 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.; McQueen, Matthew J.; Bhandari, Mohit; Bosch, Jackie; Buckley, Norman; Chow, Clara K.; Halliwell, Richard; Li, Stephen; Lee, Vincent W.; Mooney, John; Furtado, Mariana V.; Suzumura, Erica; Santucci, Eliana; Leite, Katia; Santo, Jose Amalth Do Espirirto; Jardim, Cesar A P; Cavalcanti, Alexandre Biasi; Guimaraes, Helio Penna; Jacka, Michael J.; McAlister, Finlay; McMurtry, Sean; Townsend, Derek; Pannu, Neesh; Bagshaw, Sean; Bessissow, Amal; 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; Pinthus, Jehonathan; Ribas, Sebastian; Simunovic, Marko; Tandon, Vikas; Vanhelder, Tomas; Winemaker, Mitchell; 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; Crowther, Mark; Douketis, James; Gangji, Azim; Jackson, Paul; Lim, Wendy; Lovrics, Peter; Mazzadi, Sergio; Orovan, William; Rudkowski, Jill; Soth, Mark; Tiboni, Maria; Acedillo, Rey; Hildebrand, Ainslie; Lam, Ngan; MacNeil, Danielle; 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; 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; Choi, Gordon Y S; Gin, Tony; Lit, Lydia C W; Sigamani, Alben; Faruqui, Atiya; Dhanpal, Radhika; Almeida, Smitha; Cherian, Joseph; Furruqh, Sultana; Afzal, Lalita; George, Preetha; Mala, Shaveta; 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; Valderrama-Victoria, Vanessa; Loza-Herrera, Javier D.; De Los Angeles Lazo, Maria; Rotta-Rotta, Aida; Sokolowska, Barbara; Musial, Jacek; Gorka, Jacek; Iwaszczuk, Pawel; Kozka, Mateusz; Chwala, MacIej; Raczek, Marcin; Mrowiecki, Tomasz; Kaczmarek, Bogusz; Cassimjee, Hussein; Gopalan, Dean; Kisten, Theroshnie; Mugabi, Aine; Naidoo, Prebashini; Naidoo, Rubeshan; Skinner, David; Torborg, Alex; Urrutia, Gerard; Maestre, Mari Luz; Santaló, Miquel; Gonzalez, Raúl; Font, Adrià; Martínez, Cecilia; Pelaez, Xavier; De Antonio, Marta; Villamor, Jose Marcial; García, Jesús Álvarez; Ferré, Maria José; Popova, Ekaterina; Garutti, Ignacio; 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.; 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; Sun, Zhuo; Finnegan, Patrick S.; Egan, Cameron; Honar, Hooman; Shahinyan, Aram; Panjasawatwong, Krit; Fu, Alexander Y.; Wang, Sihe; Reineks, Edmunds; Blood, Jane; Kalin, Megan; Gibson, David; Wildes, Troy.
In: Anesthesiology, Vol. 120, No. 3, 2014, p. 564-578.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Myocardial Injury after Noncardiac Surgery
T2 - A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes
AU - Botto, Fernando
AU - Alonso-Coello, Pablo
AU - Chan, Matthew T V
AU - Villar, Juan Carlos
AU - Xavier, Denis
AU - Srinathan, Sadeesh
AU - Guyatt, Gordon
AU - Cruz, Patricia
AU - Graham, Michelle
AU - Wang, C. Y.
AU - Berwanger, Otavio
AU - Pearse, Rupert M.
AU - Biccard, Bruce M.
AU - Abraham, Valsa
AU - Malaga, German
AU - Hillis, Graham S.
AU - Rodseth, Reitze N.
AU - Cook, Deborah
AU - Polanczyk, Carisi A.
AU - Szczeklik, Wojciech
AU - Sessler, Daniel I.
AU - Sheth, Tej
AU - Ackland, Gareth L.
AU - Leuwer, Martin
AU - Garg, Amit X.
AU - Lemanach, Yannick
AU - Pettit, Shirley
AU - Heels-Ansdell, Diane
AU - Luratibuse, Giovanna
AU - Walsh, Michael
AU - Sapsford, Robert
AU - Schünemann, Holger J.
AU - Kurz, Andrea
AU - Thomas, Sabu
AU - Mrkobrada, Marko
AU - Thabane, Lehana
AU - Gerstein, Hertzel
AU - Paniagua, Pilar
AU - Nagele, Peter
AU - Raina, Parminder
AU - Yusuf, Salim
AU - Devereaux, P. J.
AU - McQueen, Matthew J.
AU - Bhandari, Mohit
AU - Bosch, Jackie
AU - Buckley, Norman
AU - Chow, Clara K.
AU - Halliwell, Richard
AU - Li, Stephen
AU - Lee, Vincent W.
AU - Mooney, John
AU - Furtado, Mariana V.
AU - Suzumura, Erica
AU - Santucci, Eliana
AU - Leite, Katia
AU - Santo, Jose Amalth Do Espirirto
AU - Jardim, Cesar A P
AU - Cavalcanti, Alexandre Biasi
AU - Guimaraes, Helio Penna
AU - Jacka, Michael J.
AU - McAlister, Finlay
AU - McMurtry, Sean
AU - Townsend, Derek
AU - Pannu, Neesh
AU - Bagshaw, Sean
AU - Bessissow, Amal
AU - Duceppe, Emmanuelle
AU - Eikelboom, John
AU - Ganame, Javier
AU - Hankinson, James
AU - Hill, Stephen
AU - Jolly, Sanjit
AU - Lamy, Andre
AU - Ling, Elizabeth
AU - Magloire, Patrick
AU - Pare, Guillaume
AU - Reddy, Deven
AU - Szalay, David
AU - Tittley, Jacques
AU - Weitz, Jeff
AU - Whitlock, Richard
AU - Darvish-Kazim, Saeed
AU - Debeer, Justin
AU - Kavsak, Peter
AU - Kearon, Clive
AU - Mizera, Richard
AU - O'Donnell, Martin
AU - Pinthus, Jehonathan
AU - Ribas, Sebastian
AU - Simunovic, Marko
AU - Tandon, Vikas
AU - Vanhelder, Tomas
AU - Winemaker, Mitchell
AU - McDonald, Sarah
AU - O'Bryne, Paul
AU - Patel, Ameen
AU - Paul, James
AU - Punthakee, Zubin
AU - Raymer, Karen
AU - Salehian, Omid
AU - Spencer, Fred
AU - Walter, Stephen
AU - Worster, Andrew
AU - Adili, Anthony
AU - Clase, Catherine
AU - Crowther, Mark
AU - Douketis, James
AU - Gangji, Azim
AU - Jackson, Paul
AU - Lim, Wendy
AU - Lovrics, Peter
AU - Mazzadi, Sergio
AU - Orovan, William
AU - Rudkowski, Jill
AU - Soth, Mark
AU - Tiboni, Maria
AU - Acedillo, Rey
AU - Hildebrand, Ainslie
AU - Lam, Ngan
AU - MacNeil, Danielle
AU - Roshanov, Pavel S.
AU - Srinathan, Sadeesh K.
AU - Ramsey, Clare
AU - John, Philip St
AU - Thorlacius, Laurel
AU - Siddiqui, Faisal S.
AU - Grocott, Hilary P.
AU - McKay, Andrew
AU - Lee, Trevor W R
AU - Amadeo, Ryan
AU - Funk, Duane
AU - McDonald, Heather
AU - Zacharias, James
AU - Cortés, Olga Lucía
AU - Chaparro, Maria Stella
AU - Vásquez, Skarlett
AU - Castañeda, Alvaro
AU - Ferreira, Silvia
AU - Coriat, Pierre
AU - Monneret, Denis
AU - Goarin, Jean Pierre
AU - Esteve, Cristina Ibanez
AU - Royer, Catherine
AU - Daas, Georges
AU - Choi, Gordon Y S
AU - Gin, Tony
AU - Lit, Lydia C W
AU - Sigamani, Alben
AU - Faruqui, Atiya
AU - Dhanpal, Radhika
AU - Almeida, Smitha
AU - Cherian, Joseph
AU - Furruqh, Sultana
AU - Afzal, Lalita
AU - George, Preetha
AU - Mala, Shaveta
AU - Muti, Paola
AU - Vizza, Enrico
AU - Wang, C. Y.
AU - Ong, G. S Y
AU - Mansor, Marzida
AU - Tan, Alvin S B
AU - Shariffuddin, Ina I.
AU - Vasanthan, V.
AU - Hashim, N. H M
AU - Undok, A. Wahab
AU - Ki, Ushananthini
AU - Lai, Hou Yee
AU - Ahmad, Wan Azman
AU - Razack, Azad H A
AU - Valderrama-Victoria, Vanessa
AU - Loza-Herrera, Javier D.
AU - De Los Angeles Lazo, Maria
AU - Rotta-Rotta, Aida
AU - Sokolowska, Barbara
AU - Musial, Jacek
AU - Gorka, Jacek
AU - Iwaszczuk, Pawel
AU - Kozka, Mateusz
AU - Chwala, MacIej
AU - Raczek, Marcin
AU - Mrowiecki, Tomasz
AU - Kaczmarek, Bogusz
AU - Cassimjee, Hussein
AU - Gopalan, Dean
AU - Kisten, Theroshnie
AU - Mugabi, Aine
AU - Naidoo, Prebashini
AU - Naidoo, Rubeshan
AU - Skinner, David
AU - Torborg, Alex
AU - Urrutia, Gerard
AU - Maestre, Mari Luz
AU - Santaló, Miquel
AU - Gonzalez, Raúl
AU - Font, Adrià
AU - Martínez, Cecilia
AU - Pelaez, Xavier
AU - De Antonio, Marta
AU - Villamor, Jose Marcial
AU - García, Jesús Álvarez
AU - Ferré, Maria José
AU - Popova, Ekaterina
AU - Garutti, Ignacio
AU - Fernández, Carmen
AU - Palencia, Maria
AU - Díaz, Susana
AU - Del Castillo, Teresa
AU - Varela, Alberto
AU - De Miguel, Angeles
AU - Muñoz, Manuel
AU - Piñeiro, Patricia
AU - Cusati, Gabriel
AU - Del Barrio, Maria
AU - Membrillo, Maria José
AU - Orozco, David
AU - Reyes, Fidel
AU - Sapsford, Robert J.
AU - Barth, Julian
AU - Scott, Julian
AU - Hall, Alistair
AU - Howell, Simon
AU - Lobley, Michaela
AU - Woods, Janet
AU - Howard, Susannah
AU - Fletcher, Joanne
AU - Dewhirst, Nikki
AU - Williams, C.
AU - Rushton, A.
AU - Welters, I.
AU - Leuwer, M.
AU - Khan, Ahsun
AU - Niebrzegowska, Edyta
AU - Benton, Sally
AU - Wragg, Andrew
AU - Archbold, Andrew
AU - Smith, Amanda
AU - McAlees, Eleanor
AU - Ramballi, Cheryl
AU - MacDonald, Neil
AU - Januszewska, Marta
AU - Stephens, Robert
AU - Reyes, Anna
AU - Paredes, Laura Gallego
AU - Sultan, Pervez
AU - Cain, David
AU - Whittle, John
AU - Del Arroyo, Ana Gutierrez
AU - Sun, Zhuo
AU - Finnegan, Patrick S.
AU - Egan, Cameron
AU - Honar, Hooman
AU - Shahinyan, Aram
AU - Panjasawatwong, Krit
AU - Fu, Alexander Y.
AU - Wang, Sihe
AU - Reineks, Edmunds
AU - Blood, Jane
AU - Kalin, Megan
AU - Gibson, David
AU - Wildes, Troy
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84895432300&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84895432300&partnerID=8YFLogxK
U2 - 10.1097/ALN.0000000000000113
DO - 10.1097/ALN.0000000000000113
M3 - Article
C2 - 24534856
AN - SCOPUS:84895432300
VL - 120
SP - 564
EP - 578
JO - Anesthesiology
JF - Anesthesiology
SN - 0003-3022
IS - 3
ER -