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Identification of m...
Identification of myocardial injury using perioperative troponin surveillance in major noncardiac surgery and net benefit over the Revised Cardiac Risk Index
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- Chew, Michelle S. (author)
- Linköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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- Puelacher, Christian (author)
- University Hospital Basel,Univ Basel, Switzerland; Univ Basel, Switzerland
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- Patel, Akshaykumar (author)
- Queen Mary University,Queen Mary Univ London, England
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- Hammarskjöld, Fredrik (author)
- Ryhov County Hospital, Jönköping,Ryhov Cty Hosp, Sweden
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- Lyckner, Sara (author)
- Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Center for Clinical Research Sörmland,Malarsjukhuset, Sweden
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- Kollind, Malin (author)
- Central Hospital Kristianstad,Cent Sjukhuset Kristianstad, Sweden
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- Jawad, Monir (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Forskargrupper vid Lunds universitet,Anaesthesiology and Intensive Care Medicine,Lund University Research Groups,Central Hospital Kristianstad,Cent Sjukhuset Kristianstad, Sweden; Lund Univ, Sweden
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- Andersson, Ulrika (author)
- Lund University,Skåne University Hospital,Lund Univ, Sweden
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- Fredrikson, Mats (author)
- Linköpings universitet,Linköping University,Avdelningen för inflammation och infektion,Medicinska fakulteten
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- Sperber, Jesper (author)
- Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Center for Clinical Research Sörmland,Malarsjukhuset, Sweden
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- Johnsson, Patrik (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Forskargrupper vid Lunds universitet,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Anaesthesiology and Intensive Care Medicine,Lund University Research Groups,Skåne University Hospital,Lund Univ, Sweden
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- Elander, Louise, 1980- (author)
- Linköpings universitet,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, Anestesi- och intensivvårdskliniken VIN
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- Zeuchner, Jakob, 1985- (author)
- Linköpings universitet,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, Anestesi- och intensivvårdskliniken VIN
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- Linhardt, Michael (author)
- Linköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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- de Geer, Lina (author)
- Linköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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- Rolander, Wictor Gääw (author)
- Linköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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- Gagnö, Gunilla (author)
- Linköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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- Didriksson, Helen (author)
- Linköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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- Pearse, Rupert (author)
- Queen Mary University,Queen Mary Univ London, England
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- Mueller, Christian (author)
- University Hospital Basel,Univ Basel, Switzerland; Univ Basel, Switzerland
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- Andersson, Henrik (author)
- Linköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
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(creator_code:org_t)
- Elsevier, 2022
- 2022
- English.
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In: British Journal of Anaesthesia. - : Elsevier. - 0007-0912 .- 1471-6771. ; 128:1, s. 26-36
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https://urn.kb.se/re...
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Abstract
Subject headings
Close
- BACKGROUND: Patients with perioperative myocardial injury are at risk of death and major adverse cardiovascular and cerebrovascular events (MACCE). The primary aim of this study was to determine optimal thresholds of preoperative and perioperative changes in high-sensitivity cardiac troponin T (hs-cTnT) to predict MACCE and mortality.METHODS: Prospective, observational, cohort study in patients ≥50 yr of age undergoing elective major noncardiac surgery at seven hospitals in Sweden. The exposures were hs-cTnT measured before and days 0-3 after surgery. Two previously published thresholds for myocardial injury and two thresholds identified using receiver operating characteristic analyses were evaluated using multivariable logistic regression models and externally validated. The weighted comparison net benefit method was applied to determine the additional value of hs-cTnT thresholds when compared with the Revised Cardiac Risk Index (RCRI). The primary outcome was a composite of 30-day all-cause mortality and MACCE.RESULTS: We included 1291 patients between April 2017 and December 2020. The primary outcome occurred in 124 patients (9.6%). Perioperative increase in hs-cTnT ≥14 ng L-1 above preoperative values provided statistically optimal model performance and was associated with the highest risk for the primary outcome (adjusted odds ratio 2.9, 95% confidence interval 1.8-4.7). Validation in an independent, external cohort confirmed these findings. A net benefit over RCRI was demonstrated across a range of clinical thresholds.CONCLUSIONS: Perioperative increases in hsTnT ≥14 ng L-1 above baseline values identifies acute perioperative myocardial injury and provides a net prognostic benefit when added to RCRI for the identification of patients at high risk of death and MACCE.CLINICAL TRIAL REGISTRATION: NCT03436238.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- MACCE
- MINS
- biomarker
- cardiac troponins
- high-sensitivity cardiac troponin T
- major adverse cardiovascular and cerebrovascular events
- myocardial injury
- perioperative
- surgery
- biomarker
- cardiac troponins
- high-sensitivity cardiac troponin T
- MACCE
- major adverse cardiovascular and cerebrovascular events
- MINS
- myocardial injury
- perioperative
- surgery
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Chew, Michelle S ...
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Puelacher, Chris ...
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Patel, Akshaykum ...
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Hammarskjöld, Fr ...
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Lyckner, Sara
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Kollind, Malin
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show more...
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Jawad, Monir
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Andersson, Ulrik ...
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Fredrikson, Mats
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Sperber, Jesper
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Johnsson, Patrik
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Elander, Louise, ...
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Zeuchner, Jakob, ...
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Linhardt, Michae ...
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de Geer, Lina
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Rolander, Wictor ...
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Gagnö, Gunilla
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Didriksson, Hele ...
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Pearse, Rupert
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Mueller, Christi ...
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Andersson, Henri ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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British Journal ...
- By the university
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Uppsala University
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Lund University
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Linköping University