Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery
BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is common and of prognostic importance. Little is known about MINS in orthopaedic surgery. The diagnostic criterion for MINS was a level of ≥0.03 ng/mL on a non-high-sensitivity troponin T (TnT) assay due to myocardial ischemia. METHODS:...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Published: |
Journal of Bone and Joint Surgery, Inc.
2020
|
| Subjects: |
| _version_ | 1825722317628506112 |
|---|---|
| author | Thomas, Sabu Borges, Flavia Bhandari, Mohit De Beer, Justin Urrútia Cuchí, Gerard Adili, Anthony Winemaker, Mitchell Avram, Victoria Chan, Matthew T.V. Lamas, Claudia Cruz, Patricia Aguilera, Xavier Garutti, Ignacio Alonso-Coello, Pablo Villar, Juan Carlos Jacka, Michael Wang, C.Y. Berwanger, Otavio Chow, Clara Srinathan, Sadeesh Pettit, Shirley Heels-Ansdell, Dianne Rubery, Paul Devereaux, P.J. Thomas, Sabu Walsh, Michael Tiboni, Maria Guyatt, Gordon Heels-Ansdell, Diane Thorlund, Kristian Thabane, Lehana Bhandari, Mohit Bosch, Jackie Chan, Matthew T.V. Shatin, NT Alonso-Coello, Pablo Berwanger, Otavio Carlos Villar, Juan Wang, Chew Yin Garutti, R. Ignacio Jacka, Michael J. Sigamani, Alben Srinathan, Sadeesh Biccard, Bruce M. Rodseth, Reitze N. Chow, Clara K. Abraham, Valsa Pettit, Shirley McQueen, Matthew J. VanHelder, Tomas Szczeklik, Wojciech Buse, Giovanna Lurati Botto, Fernando Yusuf, Salim Sessler, Daniel I. Kurz, Andrea Garg, Amit X. Mrkobrada, Marko Pearse, Rupert M. Polanczyk, Carisi A. Malaga, German Nagele, Peter Le Manach, Yannick Leuwer, Martin Devereaux, P.J. |
| author_facet | Thomas, Sabu Borges, Flavia Bhandari, Mohit De Beer, Justin Urrútia Cuchí, Gerard Adili, Anthony Winemaker, Mitchell Avram, Victoria Chan, Matthew T.V. Lamas, Claudia Cruz, Patricia Aguilera, Xavier Garutti, Ignacio Alonso-Coello, Pablo Villar, Juan Carlos Jacka, Michael Wang, C.Y. Berwanger, Otavio Chow, Clara Srinathan, Sadeesh Pettit, Shirley Heels-Ansdell, Dianne Rubery, Paul Devereaux, P.J. Thomas, Sabu Walsh, Michael Tiboni, Maria Guyatt, Gordon Heels-Ansdell, Diane Thorlund, Kristian Thabane, Lehana Bhandari, Mohit Bosch, Jackie Chan, Matthew T.V. Shatin, NT Alonso-Coello, Pablo Berwanger, Otavio Carlos Villar, Juan Wang, Chew Yin Garutti, R. Ignacio Jacka, Michael J. Sigamani, Alben Srinathan, Sadeesh Biccard, Bruce M. Rodseth, Reitze N. Chow, Clara K. Abraham, Valsa Pettit, Shirley McQueen, Matthew J. VanHelder, Tomas Szczeklik, Wojciech Buse, Giovanna Lurati Botto, Fernando Yusuf, Salim Sessler, Daniel I. Kurz, Andrea Garg, Amit X. Mrkobrada, Marko Pearse, Rupert M. Polanczyk, Carisi A. Malaga, German Nagele, Peter Le Manach, Yannick Leuwer, Martin Devereaux, P.J. |
| author_sort | Thomas, Sabu |
| collection | UM |
| description | BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is common and of prognostic importance. Little is known about MINS in orthopaedic surgery. The diagnostic criterion for MINS was a level of ≥0.03 ng/mL on a non-high-sensitivity troponin T (TnT) assay due to myocardial ischemia. METHODS: We undertook an international, prospective study of 15,103 patients ≥45 years of age who had inpatient noncardiac surgery; 3,092 underwent orthopaedic surgery. Non-high-sensitivity TnT assays were performed on postoperative days 0, 1, 2, and 3. Among orthopaedic patients, we determined (1) the prognostic relevance of the MINS diagnostic criteria, (2) the 30-day mortality rate for those with and without MINS, and (3) the probable proportion of MINS cases that would go undetected without troponin monitoring because of a lack of an ischemic symptom. RESULTS: Three hundred and sixty-seven orthopaedic patients (11.9%) had MINS. MINS was associated independently with 30-day mortality including among those who had had orthopaedic surgery. Orthopaedic patients without and with MINS had a 30-day mortality rate of 1.0% and 9.8%, respectively (odds ratio [OR], 11.28; 95% confidence interval [CI], 6.72 to 18.92). The 30-day mortality rate was increased for patients with MINS who had an ischemic feature (i.e., symptoms, or evidence of ischemia on electrocardiography or imaging) (OR, 18.25; 95% CI, 10.06 to 33.10) and for those who did not have an ischemic feature (OR, 7.35; 95% CI, 3.37 to 16.01). The proportion of orthopaedic patients with MINS who were asymptomatic and in whom the myocardial injury would have probably gone undetected without TnT monitoring was 81.3% (95% CI, 76.3% to 85.4%). CONCLUSIONS: One in 8 orthopaedic patients in our study had MINS, and MINS was associated with a higher mortality rate regardless of symptoms. Troponin levels should be measured after surgery in at-risk patients because most MINS cases (>80%) are asymptomatic and would go undetected without routine measurements. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. |
| first_indexed | 2024-03-06T06:03:50Z |
| format | Article |
| id | um.eprints-24810 |
| institution | Universiti Malaya |
| last_indexed | 2024-03-06T06:03:50Z |
| publishDate | 2020 |
| publisher | Journal of Bone and Joint Surgery, Inc. |
| record_format | dspace |
| spelling | um.eprints-248102020-06-15T01:16:11Z http://eprints.um.edu.my/24810/ Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery Thomas, Sabu Borges, Flavia Bhandari, Mohit De Beer, Justin Urrútia Cuchí, Gerard Adili, Anthony Winemaker, Mitchell Avram, Victoria Chan, Matthew T.V. Lamas, Claudia Cruz, Patricia Aguilera, Xavier Garutti, Ignacio Alonso-Coello, Pablo Villar, Juan Carlos Jacka, Michael Wang, C.Y. Berwanger, Otavio Chow, Clara Srinathan, Sadeesh Pettit, Shirley Heels-Ansdell, Dianne Rubery, Paul Devereaux, P.J. Thomas, Sabu Walsh, Michael Tiboni, Maria Guyatt, Gordon Heels-Ansdell, Diane Thorlund, Kristian Thabane, Lehana Bhandari, Mohit Bosch, Jackie Chan, Matthew T.V. Shatin, NT Alonso-Coello, Pablo Berwanger, Otavio Carlos Villar, Juan Wang, Chew Yin Garutti, R. Ignacio Jacka, Michael J. Sigamani, Alben Srinathan, Sadeesh Biccard, Bruce M. Rodseth, Reitze N. Chow, Clara K. Abraham, Valsa Pettit, Shirley McQueen, Matthew J. VanHelder, Tomas Szczeklik, Wojciech Buse, Giovanna Lurati Botto, Fernando Yusuf, Salim Sessler, Daniel I. Kurz, Andrea Garg, Amit X. Mrkobrada, Marko Pearse, Rupert M. Polanczyk, Carisi A. Malaga, German Nagele, Peter Le Manach, Yannick Leuwer, Martin Devereaux, P.J. R Medicine BACKGROUND: Myocardial injury after noncardiac surgery (MINS) is common and of prognostic importance. Little is known about MINS in orthopaedic surgery. The diagnostic criterion for MINS was a level of ≥0.03 ng/mL on a non-high-sensitivity troponin T (TnT) assay due to myocardial ischemia. METHODS: We undertook an international, prospective study of 15,103 patients ≥45 years of age who had inpatient noncardiac surgery; 3,092 underwent orthopaedic surgery. Non-high-sensitivity TnT assays were performed on postoperative days 0, 1, 2, and 3. Among orthopaedic patients, we determined (1) the prognostic relevance of the MINS diagnostic criteria, (2) the 30-day mortality rate for those with and without MINS, and (3) the probable proportion of MINS cases that would go undetected without troponin monitoring because of a lack of an ischemic symptom. RESULTS: Three hundred and sixty-seven orthopaedic patients (11.9%) had MINS. MINS was associated independently with 30-day mortality including among those who had had orthopaedic surgery. Orthopaedic patients without and with MINS had a 30-day mortality rate of 1.0% and 9.8%, respectively (odds ratio [OR], 11.28; 95% confidence interval [CI], 6.72 to 18.92). The 30-day mortality rate was increased for patients with MINS who had an ischemic feature (i.e., symptoms, or evidence of ischemia on electrocardiography or imaging) (OR, 18.25; 95% CI, 10.06 to 33.10) and for those who did not have an ischemic feature (OR, 7.35; 95% CI, 3.37 to 16.01). The proportion of orthopaedic patients with MINS who were asymptomatic and in whom the myocardial injury would have probably gone undetected without TnT monitoring was 81.3% (95% CI, 76.3% to 85.4%). CONCLUSIONS: One in 8 orthopaedic patients in our study had MINS, and MINS was associated with a higher mortality rate regardless of symptoms. Troponin levels should be measured after surgery in at-risk patients because most MINS cases (>80%) are asymptomatic and would go undetected without routine measurements. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Journal of Bone and Joint Surgery, Inc. 2020 Article PeerReviewed Thomas, Sabu and Borges, Flavia and Bhandari, Mohit and De Beer, Justin and Urrútia Cuchí, Gerard and Adili, Anthony and Winemaker, Mitchell and Avram, Victoria and Chan, Matthew T.V. and Lamas, Claudia and Cruz, Patricia and Aguilera, Xavier and Garutti, Ignacio and Alonso-Coello, Pablo and Villar, Juan Carlos and Jacka, Michael and Wang, C.Y. and Berwanger, Otavio and Chow, Clara and Srinathan, Sadeesh and Pettit, Shirley and Heels-Ansdell, Dianne and Rubery, Paul and Devereaux, P.J. and Thomas, Sabu and Walsh, Michael and Tiboni, Maria and Guyatt, Gordon and Heels-Ansdell, Diane and Thorlund, Kristian and Thabane, Lehana and Bhandari, Mohit and Bosch, Jackie and Chan, Matthew T.V. and Shatin, NT and Alonso-Coello, Pablo and Berwanger, Otavio and Carlos Villar, Juan and Wang, Chew Yin and Garutti, R. Ignacio and Jacka, Michael J. and Sigamani, Alben and Srinathan, Sadeesh and Biccard, Bruce M. and Rodseth, Reitze N. and Chow, Clara K. and Abraham, Valsa and Pettit, Shirley and McQueen, Matthew J. and VanHelder, Tomas and Szczeklik, Wojciech and Buse, Giovanna Lurati and Botto, Fernando and Yusuf, Salim and Sessler, Daniel I. and Kurz, Andrea and Garg, Amit X. and Mrkobrada, Marko and Pearse, Rupert M. and Polanczyk, Carisi A. and Malaga, German and Nagele, Peter and Le Manach, Yannick and Leuwer, Martin and Devereaux, P.J. (2020) Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery. The Journal of Bone and Joint Surgery, 102 (10). pp. 880-888. ISSN 0021-9355, DOI https://doi.org/10.2106/JBJS.18.01305 <https://doi.org/10.2106/JBJS.18.01305>. https://doi.org/10.2106/JBJS.18.01305 doi:10.2106/JBJS.18.01305 |
| spellingShingle | R Medicine Thomas, Sabu Borges, Flavia Bhandari, Mohit De Beer, Justin Urrútia Cuchí, Gerard Adili, Anthony Winemaker, Mitchell Avram, Victoria Chan, Matthew T.V. Lamas, Claudia Cruz, Patricia Aguilera, Xavier Garutti, Ignacio Alonso-Coello, Pablo Villar, Juan Carlos Jacka, Michael Wang, C.Y. Berwanger, Otavio Chow, Clara Srinathan, Sadeesh Pettit, Shirley Heels-Ansdell, Dianne Rubery, Paul Devereaux, P.J. Thomas, Sabu Walsh, Michael Tiboni, Maria Guyatt, Gordon Heels-Ansdell, Diane Thorlund, Kristian Thabane, Lehana Bhandari, Mohit Bosch, Jackie Chan, Matthew T.V. Shatin, NT Alonso-Coello, Pablo Berwanger, Otavio Carlos Villar, Juan Wang, Chew Yin Garutti, R. Ignacio Jacka, Michael J. Sigamani, Alben Srinathan, Sadeesh Biccard, Bruce M. Rodseth, Reitze N. Chow, Clara K. Abraham, Valsa Pettit, Shirley McQueen, Matthew J. VanHelder, Tomas Szczeklik, Wojciech Buse, Giovanna Lurati Botto, Fernando Yusuf, Salim Sessler, Daniel I. Kurz, Andrea Garg, Amit X. Mrkobrada, Marko Pearse, Rupert M. Polanczyk, Carisi A. Malaga, German Nagele, Peter Le Manach, Yannick Leuwer, Martin Devereaux, P.J. Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery |
| title | Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery |
| title_full | Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery |
| title_fullStr | Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery |
| title_full_unstemmed | Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery |
| title_short | Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery |
| title_sort | association between myocardial injury and cardiovascular outcomes of orthopaedic surgery |
| topic | R Medicine |
| work_keys_str_mv | AT thomassabu associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT borgesflavia associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT bhandarimohit associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT debeerjustin associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT urrutiacuchigerard associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT adilianthony associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT winemakermitchell associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT avramvictoria associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT chanmatthewtv associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT lamasclaudia associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT cruzpatricia associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT aguileraxavier associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT garuttiignacio associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT alonsocoellopablo associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT villarjuancarlos associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT jackamichael associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT wangcy associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT berwangerotavio associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT chowclara associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT srinathansadeesh associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT pettitshirley associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT heelsansdelldianne associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT ruberypaul associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT devereauxpj associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT thomassabu associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT walshmichael associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT tibonimaria associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT guyattgordon associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT heelsansdelldiane associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT thorlundkristian associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT thabanelehana associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT bhandarimohit associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT boschjackie associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT chanmatthewtv associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT shatinnt associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT alonsocoellopablo associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT berwangerotavio associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT carlosvillarjuan associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT wangchewyin associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT garuttirignacio associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT jackamichaelj associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT sigamanialben associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT srinathansadeesh associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT biccardbrucem associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT rodsethreitzen associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT chowclarak associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT abrahamvalsa associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT pettitshirley associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT mcqueenmatthewj associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT vanheldertomas associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT szczeklikwojciech associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT busegiovannalurati associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT bottofernando associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT yusufsalim associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT sesslerdanieli associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT kurzandrea associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT gargamitx associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT mrkobradamarko associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT pearserupertm associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT polanczykcarisia associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT malagagerman associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT nagelepeter associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT lemanachyannick associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT leuwermartin associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery AT devereauxpj associationbetweenmyocardialinjuryandcardiovascularoutcomesoforthopaedicsurgery |