Characteristics and short-term prognosis of perioperative myocardialinfarction in patients undergoing noncardiac surgery a cohort study
Ann. intern. med
; Ann. intern. med;154(8): 523-528, 2011. ilus, tab
Article
in En
| SES-SP, SESSP-IDPCPROD, SES-SP
| ID: biblio-1059676
Responsible library:
BR79.1
Localization: BR79.1
ABSTRACT
BACKGROUND:
Each year, millions of patients worldwide have a perioperative myocardial infarction (MI) after noncardiac surgery.OBJECTIVE:
To examine the characteristics and short-term outcome of perioperative MI.DESIGN:
Cohort study. (ClinicalTrials.gov registration number NCT00182039)SETTING:
190 centers in 23 countries.PATIENTS 8351 patients included in the POISE (PeriOperative ISchemic Evaluation) trial.MEASUREMENTS Four cardiac biomarker or enzyme assays were measured within 3 days of surgery. The definition of perioperative MI included either autopsy findings of acute MI or an elevated level of a cardiac biomarker or enzyme and at least 1 of the following defining features ischemic symptoms, development of pathologic Q waves, ischemic changes on electrocardiography, coronary artery intervention, or cardiac imaging evidence of MI.RESULTS:
Within 30 days of random assignment, 415 patients (5.0%) had a perioperative MI. Most MIs (74.1%) occurred within 48 hours of surgery; 65.3% of patients did not experience ischemic symptoms. The 30-day mortality rate was 11.6% (48 of 415 patients) among patients who had a perioperative MI and 2.2% (178 of 7936 patients) among those who did not (P < 0.001). Among patients with a perioperative MI, mortality rates were elevated and similar between those with (9.7%; adjusted odds ratio, 4.76 [95% CI, 2.68 to 8.43]) and without (12.5%; adjusted odds ratio, 4.00 [CI, 2.65 to 6.06]) ischemic symptoms.LIMITATION:
Cardiac markers were measured only until day 3 after surgery, and additional asymptomatic MIs may have been missed.CONCLUSION:
Most patients with a perioperative MI will not experience ischemic symptoms. Data suggest that routine monitoring of troponin levels in at-risk patients is needed after surgery to detect most MIs, which have an equally poor prognosis regardless of whether they are symptomatic or asymptomatic.
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Collection:
06-national
/
BR
Database:
SES-SP
/
SESSP-IDPCPROD
Main subject:
Prognosis
/
Preoperative Care
/
Myocardial Infarction
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Language:
En
Journal:
Ann. intern. med
Year:
2011
Document type:
Article