Prognostic value of high-sensitivity troponin T in aneurysmal subarachnoid hemorrhage: a prospective observational study.

Objective: To evaluate the prognostic value of high-sensitivity troponin (hsT) in severe aneurysmal subarachnoid hemorrhage (aSAH). Methods: This prospective non-interventional study was performed at a surgical intensive care unit (ICU) from 2012 to 2015. Consecutive patients who had severe aSAH were included. A modified Rankin Scale score ≥ 4 or death within 3 months defined a poor outcome. hsT levels were measured at ICU admission and 72 hours following symptom onset. Results: A total of 137 patients were analyzed. The median hsT level was 29 ng/L (range: 7-4485). The best threshold level of hsT for predicting a poor outcome was 22 ng/L. At this threshold, the sensitivity was 71% (95% confidence interval [CI]: 58%-81%) and the specificity was 58% (95%CI: 46%-70%). The area under the ROC curve was 0.61 (95%CI: 0.52-0.71). Based on a multivariate analysis, the independent factors for a poor neurological prognosis were a World Federation of Neurologic Surgeons (WFNS) score ≥ 4 (odds ratio [OR]: 2.61; 95%CI: 1.04-6.56) and an hsT level > 22 ng/L (OR: 2.80; 95%CI: 1.18-6.64). Conclusion: In patients with severe aSAH, with regard for the severity of disease (assessed by the WFNS score), an hsT level > 22 ng/L at ICU admission was associated with poor outcomes.

Adherence of French cardiologists to guidelines for non-cardiac surgery.

INTRODUCTION: In order to evaluate whether cardiologists follow guidelines, we studied patients who were seen for a preoperative cardiologic consultation prior to surgery. METHODS: This retrospective study took place in two surgical units (Vascular and Orthopaedic) in two different university hospitals in 2013. The patient eligibility criteria were: planned elective surgery, cardiologic consultation prior to anaesthesiology consultation and lack of any unstable cardiac condition. The primary endpoint was determination of appropriate use of preoperative cardiac stress exams (CSE). RESULTS: The study included 238 patients who were seen by 131 different cardiologists. Of 238 patients, 60 had a CSE before surgery, but only 7/60 (12%) were deemed to be necessary. Seven out 15 (47%) patients with an indication for a CSE actually underwent said exam. Sixty-six percent of patients (156/238) had a resting trans-thoracic echocardiography before surgery, while only 27/156 (17%) were considered of appropriate use. Among patients with known coronary arterial disease, 59/73 (81%) received a statin, 60/73 (82%) received an antiplatelet agent, and 38/73 (52%) received a beta-blocker. Among patients with planned arterial surgery, 86/137 (63%) received a statin and 100/137 (73%) patients received an antiplatelet agent. Of the 159 consultation reports that were examined, only 5 (3%) mentioned the Lee score and 117 (74%) were concluded with "no contraindication" or a similar phrase. DISCUSSION: In this study, we found that guidelines were generally not used when cardiologists evaluated patients for non-cardiac surgery. This is evidenced by the number of inappropriate exams performed, the lack of true perioperative risk stratification, and incomplete optimization of long-term treatment regimens.