期刊
ANESTHESIOLOGY
卷 120, 期 3, 页码 564-578出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/ALN.0000000000000113
关键词
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资金
- Canada: Canadian Institutes of Health Research (Ottawa, Ontario, Canada)
- Heart and Stroke Foundation of Ontario (Toronto, Ontario, Canada)
- Academic Health Science Centres Alternative Funding Plan Innovation Fund Grant (Toronto, Ontario, Canada)
- Population Health Research Institute Grant (Hamilton, Ontario, Canada)
- CLARITY Research Group Grant
- McMaster University, Department of Surgery, Surgical Associates Research Grant (Hamilton, Ontario, Canada)
- Hamilton Health Science New Investigator Fund Grant (Hamilton, Ontario, Canada)
- Hamilton Health Sciences Grant (Hamilton, Ontario, Canada)
- Ontario Ministry of Resource and Innovation Grant (Toronto, Ontario, Canada)
- Stryker Canada (Waterdown, Ontario, Canada)
- McMaster University, Department of Anesthesiology (Hamilton, Ontario, Canada)
- Saint Joseph's Healthcare, Department of Medicine (Hamilton, Ontario, Canada)
- Father Sean O'Sullivan Research Centre (Hamilton, Ontario, Canada)
- McMaster University, Department of Medicine (Hamilton, Ontario, Canada)
- Roche Diagnostics Global Office (Basel, Switzerland)
- Hamilton Health Sciences Summer Studentships (Hamilton, Ontario, Canada)
- McMaster University, Department of Clinical Epidemiology and Biostatistics Grant (Hamilton, Ontario, Canada)
- McMaster University, Division of Cardiology Grant (Hamilton, Ontario, Canada)
- Canadian Network and Centre for Trials Internationally Grant (Hamilton, Ontario, Canada)
- Winnipeg Health Sciences Foundation Operating Grant (Winnipeg, Manitoba, Canada)
- University of Manitoba, Department of Surgery Research Grant Winnipeg, Manitoba, Canada)
- Diagnostic Services of Manitoba Research Grant (Winnipeg, Manitoba, Canada)
- Manitoba Medical Services Foundation Grant (Winnipeg, Manitoba, Canada)
- Manitoba Health Research Council Grant (Winnipeg, Manitoba, Canada)
- University of Manitoba, Faculty of Dentistry Operational Fund (Winnipeg, Manitoba, Canada)
- University of Manitoba, Department of Anesthesia Grant (Winnipeg, Manitoba, Canada)
- University Medical Group, Department of Surgery, University of Manitoba (Winnipeg, Manitoba, Canada)
- Australia: National Health and Medical Research Council Program Grant (Canberra, Australia)
- Brazil: Projeto Hospitais de Excelencia a Servico do SUS (PROADI-SUS)
- Brazilian Ministry of Health
- China: Public Policy Research Fund, Research Grant Council, Hong Kong SAR (Hong Kong)
- General Research Fund, Research Grant Council, Hong Kong SAR (Hong Kong)
- Australian and New Zealand College of Anesthesiologists Grant (Sydney, Australia)
- Colombia: School of Nursing, Universidad Industrial de Santander (Bucaramanga, Colombia)
- Grupo de Cardiolog a Preventiva, Universidad Autonoma de Bucaramanga (Bucaramanga, Colombia)
- Fundacion Cardioinfantil - Instituto de Cardiolog a (Bogota, Colombia)
- Alianza Diagnostica S. A. (Bucaramanga, Colombia)
- India: St. John's Medical College and Research Institute Grant, Division of Clinical Research and Training Grant (Bangalore, India)
- Malaysia: University of Malaya Research Grant (UMRG) (Kuala Lumpur, Malaysia)
- University of Malaya, Penyelidikan Jangka Pendek Grant (PJP) (Kuala Lumpur, Malaysia)
- Spain: Instituto de Salud Carlos III (Madrid, Spain)
- Fundacio La Marato de TV3 (Esplugues de Llobregat, Spain)
- United States: American Heart Association Grant (Dallas, Texas)
- United Kingdom: National Institute for Health Research (NIHR) (London, United Kingdom)
- National Institute for General Medical Sciences, National Institutes of Health (Bethesda, Maryland) [K23 GM087534]
- [UL1RR024992]
- Academy of Medical Sciences (AMS) [AMS-CSF3-Ackland] Funding Source: researchfish
- National Institute for Health Research [RP_2014-04-022, CS/08/08/17] Funding Source: researchfish
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.
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