Myocardial Injury after Noncardiac Surgery A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

被引：710

作者：

Botto, Fernando ^{[1
,2
]}

Alonso-Coello, Pablo ^{[3
]}

Chan, Matthew T. V. ^{[4
]}

Carlos Villar, Juan ^{[5
]}

Xavier, Denis ^{[6
]}

Srinathan, Sadeesh ^{[7
]}

Guyatt, Gordon ^{[8
,9
]}

Cruz, Patricia ^{[10
]}

Graham, Michelle ^{[11
]}

Wang, C. Y. ^{[12
]}

Berwanger, Otavio ^{[13
,19
]}

Pearse, Rupert M. ^{[14
]}

Biccard, Bruce M. ^{[15
]}

Abraham, Valsa ^{[16
]}

Malaga, German ^{[17
]}

Hillis, Graham S. ^{[18
]}

Rodseth, Reitze N. ^{[1
,15
]}

Cook, Deborah ^{[8
,9
,33
]}

Polanczyk, Carisi A. ^{[19
]}

Szczeklik, Wojciech ^{[20
]}

Sessler, Daniel I. ^{[21
]}

Sheth, Tej ^{[1
,9
,31
]}

Ackland, Gareth L. ^{[22
]}

Leuwer, Martin ^{[23
]}

Garg, Amit X. ^{[24
]}

LeManach, Yannick ^{[1
,8
,25
,26
]}

Pettit, Shirley ^{[1
]}

Heels-Ansdell, Diane ^{[8
]}

LuratiBuse, Giovanna ^{[1
,8
]}

Walsh, Michael ^{[1
,8
,9
]}

Sapsford, Robert ^{[27
]}

Schuenemann, Holger J. ^{[8
,9
]}

Kurz, Andrea ^{[21
]}

Thomas, Sabu ^{[1
,8
]}

Mrkobrada, Marko ^{[1
,8
,24
,34
]}

Thabane, Lehana ^{[8
]}

Gerstein, Hertzel ^{[1
,8
,9
,29
]}

Paniagua, Pilar ^{[3
,38
]}

Nagele, Peter ^{[28
]}

Raina, Parminder ^{[8
]}

Yusuf, Salim ^{[1
,8
,9
]}

Devereaux, P. J. ^{[1
,8
,9
]}

McQueen, Matthew J. ^{[29
]}

Bhandari, Mohit ^{[8
,29
,30
]}

Bosch, Jackie ^{[1
]}

Buckley, Norman ^{[25
]}

Chow, Clara K. ^{[18
]}

Halliwell, Richard ^{[18
]}

Li, Stephen ^{[18
]}

Lee, Vincent W. ^{[18
]}

机构：

[1] Populat Hlth Res Inst, Hamilton, ON, Canada

[2] Estudios Clin Latino Amer, Dept Clin Res, Rosario, Santa Fe, Argentina

[3] Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain

[4] Chinese Univ Hong Kong, Shatin, Hong Kong, Peoples R China

[5] Univ Autonoma Bucaramanga, Bucaramanga, Colombia

[6] St Johns Med Coll & Res Inst, Bangalore, Karnataka, India

[7] Univ Manitoba, Dept Surg, Winnipeg, MB R3T 2N2, Canada

[8] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada

[9] McMaster Univ, Dept Med, Hamilton, ON, Canada

[10] Univ Gregorio Maranon, Gen Hosp, Madrid, Spain

[11] Univ Alberta, Edmonton, AB, Canada

[12] Univ Malaya, Kuala Lumpur, Malaysia

[13] Hosp Coracao, Res Inst Hcor, Sao Paulo, Brazil

[14] Barts & London Queen Marys Sch Med & Dent, London, England

[15] Univ Kwazulu Natal, Durban, South Africa

[16] Christian Med Coll & Hosp, Ludhiana, Punjab, India

[17] Univ PeruanaCayetano Heredia, Lima, Peru

[18] Univ Sydney, George Inst Global Hlth, Sydney, NSW 2006, Australia

[19] Univ Fed Rio Grande do Sul, Hosp Clin Porto Alegre, BR-90046900 Porto Alegre, RS, Brazil

[20] Jagiellonian Univ, Coll Med, Krakow, Poland

[21] Cleveland Clin, Cleveland, OH 44106 USA

[22] UCL, London, England

[23] Univ Liverpool, Inst Translat Med, Liverpool L69 3BX, Merseyside, England

[24] London Hlth Sci Ctr, London, ON, Canada

[25] McMaster Univ, Dept Anesthesia, Hamilton, ON, Canada

[26] Univ Paris 06, Grp Hosp Pitie Salpetriere, Dept Anesthesiol & Crit Care, Paris, France

[27] Leeds Teaching Hosp, Leeds, W Yorkshire, England

[28] Washington Univ, Sch Med, St Louis, MO USA

[29] Hamilton Hlth Sci Ctr, Hamilton, ON, Canada

[30] McMaster Univ, Dept Surg, Hamilton, ON L8S 4L8, Canada

[31] Hamilton Hlth Sci Ctr, Juravinski Hosp & Canc Ctr, Hamilton, ON, Canada

[32] McMaster Univ, Med Ctr, Hamilton, ON L8S 4L8, Canada

[33] St Josephs Hlth Care, Hamilton, ON, Canada

[34] Victoria Hosp, London Hlth Sci Ctr, London, ON, Canada

[35] Winnipeg Hlth Sci Ctr, Winnipeg, MB, Canada

[36] Univ Paris 06, Hosp Pitie Salpetriere, Paris, France

[37] Natl Canc Inst Regina Elena, Rome, Italy

[38] Biomed Res Inst St Pau, Barcelona, Spain

[39] Royal London Hosp, London, England

来源：

ANESTHESIOLOGY | 2014年 / 120卷 / 03期

基金：

美国国家卫生研究院; 英国医学研究理事会; 加拿大健康研究院;

关键词：

MORTALITY; INFARCTION; STRATEGY; EVENTS; RISK;

D O I：

10.1097/ALN.0000000000000113

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

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.

引用

页码：564 / 578

页数：15

共 21 条

[1] Perioperative myocardial injury after elective open abdominal aortic aneurysm repair predicts outcome [J].

Ali, Z. A. ;

Callaghan, C. J. ;

Ali, A. A. ;

Sheikh, A. Y. ;

Akhtar, A. ;

Pavlovic, A. ;

Nouraei, S. A. Reza ;

Dutka, D. P. ;

Gaunt, M. E. .

EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2008, 35 (04) :413-419

[2]

[Anonymous], 2009, EVID BASED CARDIOL

[3] What you see may not be what you get: A brief, nontechnical introduction to overfitting in regression-type models [J].

Babyak, MA .

PSYCHOSOMATIC MEDICINE, 2004, 66 (03) :411-421

[4]

Baigent C, 2002, BMJ-BRIT MED J, V324, P71, DOI 10.1136/bmj.324.7329.71

[5] ESTIMATING THE POPULATION ATTRIBUTABLE RISK FOR MULTIPLE RISK-FACTORS USING CASE-CONTROL DATA [J].

BRUZZI, P ;

GREEN, SB ;

BYAR, DP ;

BRINTON, LA ;

SCHAIRER, C .

AMERICAN JOURNAL OF EPIDEMIOLOGY, 1985, 122 (05) :904-913

[6] BACKWARD, FORWARD AND STEPWISE AUTOMATED SUBSET-SELECTION ALGORITHMS - FREQUENCY OF OBTAINING AUTHENTIC AND NOISE VARIABLES [J].

DERKSEN, S ;

KESELMAN, HJ .

BRITISH JOURNAL OF MATHEMATICAL & STATISTICAL PSYCHOLOGY, 1992, 45 :265-282

[7] Effects of extended-release metoprolol succinate inpatients undergoing non-cardiac surgery (POISE trial):: a randomised controlled trial [J].

Devereaux, P. J. ;

Yang, Homer ;

Yusuf, Salim ;

Guyatt, Gordon ;

Leslie, Kate ;

Villar, Juan Carlos ;

Xavier, Denis ;

Chrolavicius, Susan ;

Greenspan, Launi ;

Pogue, Janice ;

Pais, Prem ;

Liu, Lisheng ;

Xu, Shouchun ;

Malaga, German ;

Avezum, Alvaro ;

Chan, Matthew ;

Montori, Victor M. ;

Jacka, Mike ;

Choi, Peter .

LANCET, 2008, 371 (9627) :1839-1847

[8] Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery [J].

Devereaux, P. J. ;

Chan, Matthew T. V. ;

Alonso-Coello, Pablo ;

Walsh, Michael ;

Berwanger, Otavio ;

Villar, Juan Carlos ;

Wang, C. Y. ;

Garutti, R. Ignacio ;

Jacka, Michael J. ;

Sigamani, Alben ;

Srinathan, Sadeesh ;

Biccard, Bruce M. ;

Chow, Clara K. ;

Abraham, Valsa ;

Tiboni, Maria ;

Pettit, Shirley ;

Szczeklik, Wojciech ;

Buse, Giovanna Lurati ;

Botto, Fernando ;

Guyatt, Gordon ;

Heels-Ansdell, Diane ;

Sessler, Daniel I. ;

Thorlund, Kristian ;

Garg, Amit X. ;

Mrkobrada, Marko ;

Thomas, Sabu ;

Rodseth, Reitze N. ;

Pearse, Rupert M. ;

Thabane, Lehana ;

McQueen, Matthew J. ;

VanHelder, Tomas ;

Bhandari, Mohit ;

Bosch, Jackie ;

Kurz, Andrea ;

Polanczyk, Carisi ;

Malaga, German ;

Nagele, Peter ;

Le Manach, Yannick ;

Leuwer, Martin ;

Yusuf, Salim .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2012, 307 (21) :2295-2304

[9] Characteristics and Short- Term Prognosis of Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery A Cohort Study [J].

Devereaux, P. J. ;

Xavier, Denis ;

Pogue, Janice ;

Guyatt, Gordon ;

Sigamani, Alben ;

Garutti, Ignacio ;

Leslie, Kate ;

Rao-Melacini, Purnima ;

Chrolavicius, Sue ;

Yang, Homer ;

MacDonald, Colin ;

Avezum, Alvaro ;

Lanthier, Luc ;

Hu, Weijiang ;

Yusuf, Salim .

ANNALS OF INTERNAL MEDICINE, 2011, 154 (08) :523-528

[10] Population attributable risks of esophageal and gastric cancers [J].

Engel, LS ;

Chow, WH ;

Vaughan, TL ;

Gammon, MD ;

Risch, HA ;

Stanford, JL ;

Schoenberg, JB ;

Mayne, ST ;

Dubrow, R ;

Rotterdam, H ;

West, AB ;

Blaser, M ;

Blot, WJ ;

Gail, MH ;

Fraumeni, JF .

JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2003, 95 (18) :1404-1413

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