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Identification of m...
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Chew, Michelle S.Linköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US
(author)
Identification of myocardial injury using perioperative troponin surveillance in major noncardiac surgery and net benefit over the Revised Cardiac Risk Index
- Article/chapterEnglish2022
Publisher, publication year, extent ...
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Elsevier,2022
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electronicrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:uu-491908
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-491908URI
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https://doi.org/10.1016/j.bja.2021.10.006DOI
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https://lup.lub.lu.se/record/a7a289df-3530-48f0-9bfc-3d698c57a05eURI
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https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-182754URI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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Funding Agencies|Swedish Research CouncilSwedish Research CouncilEuropean Commission [2019-02833]; South Eastern Sweden Research Council [746981, 712291]; Linkoping University-Region Ostergotland ALF [687681, 792291]; Swiss National Science FoundationSwiss National Science Foundation (SNSF)European Commission [320030-179362]; Swiss Heart Foundation; University Hospital of Basel; Roche Diagnostics; University of Basel; AstraZenecaAstraZeneca
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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 and genre
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Puelacher, ChristianUniversity Hospital Basel,Univ Basel, Switzerland; Univ Basel, Switzerland
(author)
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Patel, AkshaykumarQueen Mary University,Queen Mary Univ London, England
(author)
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Hammarskjöld, FredrikRyhov County Hospital, Jönköping,Ryhov Cty Hosp, Sweden
(author)
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Lyckner, SaraUppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Center for Clinical Research Sörmland,Malarsjukhuset, Sweden
(author)
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Kollind, MalinCentral Hospital Kristianstad,Cent Sjukhuset Kristianstad, Sweden
(author)
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Jawad, MonirLund 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(Swepub:lu)med-mjd
(author)
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Andersson, UlrikaLund University,Skåne University Hospital,Lund Univ, Sweden
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Fredrikson, MatsLinköpings universitet,Linköping University,Avdelningen för inflammation och infektion,Medicinska fakulteten(Swepub:liu)matfr43
(author)
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Sperber, JesperUppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Center for Clinical Research Sörmland,Malarsjukhuset, Sweden
(author)
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Johnsson, PatrikLund 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(Swepub:lu)pa7051jo
(author)
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Elander, Louise,1980-Linköpings universitet,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, Anestesi- och intensivvårdskliniken VIN(Swepub:liu)louka86
(author)
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Zeuchner, Jakob,1985-Linköpings universitet,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, Anestesi- och intensivvårdskliniken VIN(Swepub:liu)jakze88
(author)
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Linhardt, MichaelLinköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US(Swepub:liu)n/a
(author)
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de Geer, LinaLinköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US(Swepub:liu)linde65
(author)
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Rolander, Wictor GääwLinköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US(Swepub:liu)n/a
(author)
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Gagnö, GunillaLinköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US(Swepub:liu)n/a
(author)
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Didriksson, HelenLinköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US(Swepub:liu)n/a
(author)
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Pearse, RupertQueen Mary University,Queen Mary Univ London, England
(author)
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Mueller, ChristianUniversity Hospital Basel,Univ Basel, Switzerland; Univ Basel, Switzerland
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Andersson, HenrikLinköpings universitet,Linköping University,Avdelningen för klinisk kemi och farmakologi,Medicinska fakulteten,Region Östergötland, ANOPIVA US(Swepub:liu)henan81
(author)
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Linköping UniversityAvdelningen för klinisk kemi och farmakologi
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In:British Journal of Anaesthesia: Elsevier128:1, s. 26-360007-09121471-6771
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Puelacher, Chris ...
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Patel, Akshaykum ...
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Lyckner, Sara
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Kollind, Malin
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Jawad, Monir
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