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Myocardial injury after noncardiac surgery and its association with short-term mortality.

Abstract：

BACKGROUND:To identify patients at risk for postoperative myocardial injury and death, measuring cardiac troponin routinely after noncardiac surgery has been suggested. Such monitoring was implemented in our hospital. The aim of this study was to determine the predictive value of postoperative myocardial injury, as measured by troponin elevation, on 30-day mortality after noncardiac surgery. METHODS AND RESULTS:This observational, single-center cohort study included 2232 consecutive intermediate- to high-risk noncardiac surgery patients aged ≥60 years who underwent surgery in 2011. Troponin was measured on the first 3 postoperative days. Log binomial regression analysis was used to estimate the association between postoperative myocardial injury (troponin I level >0.06 μg/L) and all-cause 30-day mortality. Myocardial injury was found in 315 of 1627 patients in whom troponin I was measured (19%). All-cause death occurred in 56 patients (3%). The relative risk of a minor increase in troponin (0.07-0.59 μg/L) was 2.4 (95% confidence interval, 1.3-4.2; P<0.01), and the relative risk of a 10- to 100-fold increase in troponin (≥0.60 μg/L) was 4.2 (95% confidence interval, 2.1-8.6; P<0.01). A myocardial infarction according to the universal definition was diagnosed in 10 patients (0.6%), of whom 1 (0.06%) had ST-segment elevation myocardial infarction. CONCLUSIONS:Postoperative myocardial injury is an independent predictor of 30-day mortality after noncardiac surgery. Implementation of postoperative troponin monitoring as standard of care is feasible and may be helpful in improving the prognosis of patients undergoing noncardiac surgery.

journal_name

Circulation

journal_title

Circulation

authors

van Waes JA,Nathoe HM,de Graaff JC,Kemperman H,de Borst GJ,Peelen LM,van Klei WA,Cardiac Health After Surgery (CHASE) Investigators.

doi

10.1161/CIRCULATIONAHA.113.002128

subject

Has Abstract

pub_date

2013-06-11 00:00:00

pages

2264-71

issue

23

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.113.002128

journal_volume

127

pub_type

临床试验,杂志文章

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