scholarly journals Added value of subjective assessed functional capacity before non-cardiac surgery in predicting postoperative myocardial injury

2020 ◽  
pp. 204748732090691
Author(s):  
Marije Marsman ◽  
Judith AR van Waes ◽  
Remco B Grobben ◽  
Corien SA Weersink ◽  
Wilton A van Klei
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Functional Capacity ◽  
Myocardial Injury ◽  
Added Value ◽  
Cardiac Complications ◽  
Tertiary Referral Hospital ◽  
Postoperative Myocardial Infarction ◽  
Observational Cohort ◽  
One Year

Background Functional capacity is used as an indicator for cardiac testing before non-cardiac surgery and is often performed subjectively. However, the value of subjectively estimated functional capacity in predicting cardiac complications is under debate. We determined the predictive value of subjectively assessed functional capacity on postoperative cardiac complications and mortality. Design An observational cohort study in patients aged 60 years and over undergoing elective inpatient non-cardiac surgery in a tertiary referral hospital. Methods Subjective functional capacity was determined by anaesthesiologists. The primary outcome was postoperative myocardial injury. Secondary outcomes were postoperative inhospital myocardial infarction and one year mortality. Logistic regression analysis and area under the receiver operating curves were used to determine the added value of functional capacity. Results A total of 4879 patients was included; 824 (17%) patients had a poor subjective functional capacity. Postoperative myocardial injury occurred in 718 patients (15%). Poor functional capacity was associated with myocardial injury (relative risk (RR) 1.7, 95% confidence interval (CI) 1.5–2.0; P < 0.001), postoperative myocardial infarction (RR 2.9, 95% CI 1.9–4.2; P < 0.001) and one year mortality (RR 1.7, 95% CI 1.4–2.0; P < 0.001). After adjustment for other predictors, functional capacity was still a significant predictor for myocardial injury (odds ratio (OR) 1.3, 95% CI 1.0–1.7; P = 0.023), postoperative myocardial infarction (OR 2.0, 95% CI 1.3–3.0; P = 0.002) and one year mortality (OR 1.4, 95% CI 1.1–1.8; P = 0.003), but had no added value on top of other predictors. Conclusions Subjectively assessed functional capacity is a predictor of postoperative myocardial injury and death, but had no added value on top of other preoperative predictors.

Feasibility of hybrid telerehabilitation as component of a novel comprehensive care program after acute myocardial infarction in a one-year follow-up preliminary experience of a single center

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
E Piotrowicz ◽  
P Orzechowski ◽  
I Kowalik ◽  
R Piotrowicz
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Heart Rate ◽  
Functional Capacity ◽  
Care Program ◽  
Comprehensive Care ◽  
Monitoring Center ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Health Fund Background. A novel comprehensive care program after acute myocardial infarction (AMI) „KOS-zawał" was implemented in Poland. It includes acute intervention, complex revascularization, implantation of cardiovascular electronic devices (in case of indications), rehabilitation or hybrid telerehabilitation (HTR) and scheduled outpatient follow-up. HTR is a unique component of this program. The purpose of the pilot study was to evaluate a feasibility, safety and patients’ acceptance of HTR as component of a novel care program after AMI and to assess mortality in a one-year follow-up. Methods The study included 55 patients (LVEF 55.6 ± 6.8%; aged 57.5 ± 10.5 years). Patients underwent a 5-week HTR based on Nordic walking, consisting of an initial stage (1 week) conducted within an outpatient center and a basic stage (4-week) home-based telerehabilitation five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise training. The influence on physical capacity was assessed by comparing changes in functional capacity (METs) from the beginning and the end of HTR. Patients filled in a questionnaire in order to assess their acceptance of HTR at the end of telerehabilitation. Results HTR resulted in a significant improvement in functional capacity and workload duration in exercise test (Table). Safety: there were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the monitoring center. Prognosis all patients survived in a one-year follow-up. Conclusions Hybrid telerehabilitation is a feasible, safe form of rehabilitation, well accepted by patients. There were no deaths in a one-year follow-up. Outcomes before and after HTR Before telerehabilitation After telerehabilitation P Exercise time [s] 381.5 ± 92.0 513.7 ± 120.2 &lt;0.001 Maximal workload [MET] 7.9 ± 1.8 10.1 ± 2.3 &lt;0.001 Heart rate rest [bpm] 68.6 ± 12.0 66.6 ± 10.9 0.123 Heart rate max effort [bpm] 119.7 ± 15.9 131.0 ± 20.1 &lt;0.001 SBP rest [mmHg] 115.6 ± 14.8 117.7 ± 13.8 0.295 DBP rest [mmHg] 74.3 ± 9.2 76.2 ± 7.3 0.079 SBP max effort [mm Hg] 159.5 ± 25.7 170.7 ± 25.5 0.003 DBP max effort [mm Hg] 84.5 ± 9.2 87.2 ± 9.3 0.043 SBP systolic blood pressure, DBP diastolic blood pressure.

scholarly journals P774 Utility of global longitudinal strain to predict post-operative outcomes in non-cardiac surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C J Park ◽  
L S Tan ◽  
P Huang ◽  
P J Tan ◽  
J H J See
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Risk Stratification ◽  
Longitudinal Strain ◽  
Myocardial Injury ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Operative Outcomes ◽  
Lv Dysfunction

Abstract Background Pre-operative echocardiography is performed in selected groups of patients for cardiac risk stratification prior to surgery. Many parameters, including Left Ventricular Ejection Fraction (LVEF), are assessed during echocardiography. While many studies have cited association between low LVEF and poor operative outcomes such as perioperative myocardial infarction or cardiogenic pulmonary edema, LVEF has limitations such as left ventricular (LV) cavity border tracing, geometric assumptions and inter-observer variability. LVEF may also appear normal in the presence of LV hypertrophy and a small LV cavity size. Studies have described the routine use of global longitudinal strain (GLS) as an alternative measure of ventricular function, with GLS having been reported to be a reliable marker in detecting subclinical LV dysfunction. This adds incremental value in predicting myocardial function and in risk stratification. In fact, some studies have documented GLS being a useful preoperative parameter in predicting postoperative LV dysfunction after cardiac valve surgery. Purpose The aim of this study is to determine the value of GLS in predicting post-operative outcomes in patients undergoing non-cardiac surgeries. Methods This was a retrospective study of all patients who had echocardiography performed for a pre-operative indication from February 2017 to October 2017. These patients were screened for those who had normal LVEF, had undergone subsequent non-cardiac surgery, and had post-operative troponins measured. Medical records were traced for baseline demographics, past medical history and echocardiographic features. GLS evaluation was prospectively performed using TOMTEC-ARENA (TOMTEC Imaging Systems GmbH) by assessors blinded to patient outcomes. Outcomes for major adverse cardiovascular events and mortality up to 1 year post surgery were collected. Post-op myocardial injury was defined as a peak Troponin T value of &gt;30 ng/L or a &gt;20% increment from baseline. Results A total of 42 patients were included. 61.9% (n = 26) were male and mean age was 72.3 years. Only 75.6% of patients were fully independent with activities of daily living and mean creatinine was 153.4μmol/L. Mortality at 1 year was 16.7% (n = 7) and 28.6% (n = 12) were deemed to have post-operative myocardial injury. 1-year mortality was associated with a lower GLS (-23.8% vs -19.2%, p = 0.001). However, GLS was not correlated with post-operative myocardial injury or hospital readmissions. In our study population, only a history of past myocardial infarction predicted post-op myocardial injury (58.3% vs 16.7%, p = 0.019). Conclusion Our study did not demonstrate the utility of GLS in predicting post-operative events, but this is likely because of the small sample size with low event rates. Nevertheless, GLS values did correlate with 1-year mortality and could be a marker of frailty and an increased mortality risk.

scholarly journals The One Year Incidence of Postoperative Myocardial Infarction in an Orthopedic Population

2007 ◽  
Vol 4 (1) ◽  
pp. 76-80 ◽  
Author(s):  
M. K. Urban ◽  
K. Jules-Elysee ◽  
C. Loughlin ◽  
W. Kelsey ◽  
E. Flynn
Keyword(s):  
Myocardial Infarction ◽  
Postoperative Myocardial Infarction ◽  
One Year ◽  
The One

scholarly journals Combining CHA2DS2-VASc score into RCRI for prediction perioperative cardiovascular outcomes in patients undergoing non-cardiac surgery: a retrospective pilot study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Song-Yun Chu ◽  
Pei-Wen Li ◽  
Fang-Fang Fan ◽  
Xiao-Ning Han ◽  
Lin Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Surgery ◽  
Clinical Decision Making ◽  
Characteristic Curve ◽  
Risk Index ◽  
Cardiac Complications ◽  
Discriminative Ability ◽  
Net Reclassification Improvement ◽  
Secondary Outcomes

Abstract Background Treatment decisions in patients undergoing non-cardiac surgery are based on clinical assessment. The Revised Cardiac Risk Index (RCRI) is pragmatic and widely used but has only moderate discrimination. We aimed to test the efficacy of the CHA2DS2-VASc score and the combination of CHA2DS2-VASc and RCRI to predict perioperative risks for non-cardiac surgery. Methods This pre-specified analysis was performed in a retrospective cohort undergoing intra-abdominal surgery in our center from July 1st, 2007 to June 30th, 2008. The possible association between the baseline characteristics (as defined by CHA2DS2-VASc and RCRI) and the primary outcome of composite perioperative cardiac complications (myocardial infarction, cardiac ischemia, heart failure, arrhythmia, stroke, and/or death) and secondary outcomes of individual endpoints were explored using multivariate Logistic regression. The area under the receiver operating characteristic curve (C-statistic) was used for RCRI, CHA2DS2-VASc, and the combined models, and the net reclassification improvement (NRI) was calculated to assess the additional discriminative ability. Results Of the 1079 patients (age 57.5 ± 17.0 years), 460 (42.6%) were women. A total of 83 patients (7.7%) reached the primary endpoint. Secondary outcomes included 52 cardiac ischemic events, 40 myocardial infarction, 20 atrial fibrillation, 18 heart failure, four strokes, and 30 deaths. The endpoint events increased with the RCRI and CHA2DS2-VASc grade elevated (P < 0.05 for trend). The RCRI showed a moderate predictive ability with a C-statistics of 0.668 (95%CI 0.610–0.725) for the composite cardiac outcome. The C-statistics for the CHA2DS2-VASc was 0.765 (95% CI 0.709–0.820), indicating better performance than the RCRI (p = 0.011). Adding the CHA2DS2-VASc to the RCRI further increased the C-statistic to 0.774(95%CI 0.719–0.829), improved sensitivity, negative predictive value, and enhanced reclassification in reference to RCRI. Similar performance of the combined scores was demonstrated in the analysis of individual secondary endpoints. The best cut-off of a total of 4 scores was suggested for the combined CHA2DS2-VASc and RCRI in the prediction of the perioperative cardiac outcomes. Conclusions The CHA2DS2-VASc score significantly enhanced risk assessment for the composite perioperative cardiovascular outcome in comparison to traditional RCRI risk stratification. Incorporation of CHA2DS2-VASc scores into clinical-decision making to improve perioperative management in patients undergoing non-cardiac surgery warrants consideration.

scholarly journals Szívinfarktust túlélt betegek terápiahűsége a másodlagos megelőzés szempontjából fontos gyógyszeres kezelésekhez

2017 ◽  
Vol 158 (27) ◽  
pp. 1051-1057 ◽  
Author(s):  
András Jánosi ◽  
Péter Ofner ◽  
Zoltán Kiss ◽  
Levente Kiss ◽  
Róbert Gábor Kiss ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Beta Blockers ◽  
Platelet Aggregation Inhibitors ◽  
Hospital Treatment ◽  
Evidence Based ◽  
Index Event ◽  
Aggregation Inhibitors ◽  
Observational Cohort ◽  
Long Term Prognosis ◽  
One Year

Abstract: Introduction and aim: The aim was to study the patients’ adherence to some evidence-based medication (statins, beta blockers, platelet and RAS inhibitors) after suffering a myocardial infarction, and its impact on the outcome. Method: Retrospective observational cohort study was carried out from the data of the Hungarian Myocardial Infarction Registry between January 1, 2013, and December 31, 2014. 14,843 patients were alive at the end of hospital treatment, from them, those who had no myocardial infarction or death until 180 days were followed for one year. The adherence was defined as the proportion of time from the index event to the endpoint (or censoring) covered with prescription fillings. The endpoint was defined as death or reinfarction. Information on filling prescriptions for statins, platelet aggregation inhibitors, beta blockers and ARB/ACEI-inhibitors were obtained. Multivariate regression was used to model adherence and survival time. Results: Good adherence (\>80%) to clopidogrel, statins, beta blockers, aspirin and ARB/ACEI was found in 64.9%, 54.4%, 36.5%, 31.7% and 64.0%, respectively. Patients treated with PCI during the index hospitalization had higher adherence to all medication (all p<0.01), except for beta-blocker (p = 0.484). Multivariate analysis confirmed that adherence to statins, to clopidogrel and ARB/ACEI-inhibitors was associated with 10.1% (p<0.0001), 10.4% (p = 0.0002) and 15.8% (p<0.0001) lower hazard of endpoint respectively for 25% points increase in adherence, controlling for age, sex, performing of PCI, 5 anamnestic data and date of index event. Adherence to aspirin and beta blockers was not significantly associated with the hazard. Conclusion: Higher adherence to some evidence-based medications was found to be associated with improved long term prognosis of the patients. Orv Hetil. 2017; 158(27): 1051–1057.

Heparin-Coated Stents Do Not Protect Cancer Patients from Cardiac Complications after Noncardiac Surgery

2009 ◽  
Vol 75 (1) ◽  
pp. 61-65
Author(s):  
Karen L. Sherman ◽  
Shawn H. Obi ◽  
Gerard V. Aranha ◽  
Katherine A. Yao ◽  
Margo C. Shoup
Keyword(s):  
Myocardial Infarction ◽  
Cancer Patients ◽  
Stent Placement ◽  
Noncardiac Surgery ◽  
Coronary Stents ◽  
Cardiac Complications ◽  
Antithrombotic Agents ◽  
Positive Correlation ◽  
Patients With Cancer ◽  
Postoperative Myocardial Infarction

Previous studies regarding preoperative coronary stents and antithrombotic agents have excluded patients with cancer as a result of hypercoagulability. The objective of this study is to determine whether preoperative heparin-coated coronary stents are as safe in patients with cancer undergoing surgery as patients without cancer. Between February 2003 and February 2005, 29 patients had heparin-coated coronary stents placed before noncardiac surgery. The incidence of postoperative myocardial infarction (MI) and/or death was compared in patients with and without cancer, and outcomes were further evaluated based on preoperative antithrombotic status. Postoperative MI occurred in three of 13 (23%) patients with cancer compared with zero of 16 non-cancer patients. Patients with cancer were 9.6 times more likely to have a postoperative MI resulting in death compared with noncancer patients. There was a positive correlation between patients having cancer and having a postoperative MI ( r = 0.38, P = 0.044) and between patients with cancer being on antithrombotic medications during surgery and having a postoperative MI ( r = 0.567, P = 0.044). After stent placement, patients with cancer undergoing surgery experienced a higher incidence of postoperative MI resulting in death compared with noncancer patients despite continued antithrombotic use. In these patients, alternatives to stenting should be considered to avoid perioperative cardiac complications.

scholarly journals Lesión miocárdica perioperatoria en cirugía no cardiaca

2020 ◽  
Vol 12 (2) ◽  
pp. 3
Author(s):  
Daniel Paz Martín
Keyword(s):  
Cardiac Surgery ◽  
Cardiovascular Risk ◽  
Myocardial Injury ◽  
The Other ◽  
High Cardiovascular Risk ◽  
One Year ◽  
The One

La lesión miocárdica perioperatoria (LMP) en cirugía no cardiaca es una complicación, a menudo no identificada, que se relaciona con un aumento de mortalidad a 30 días. Los objetivos del presente trabajo son por una parte, conocer la incidencia de LMP, que se encuentra entorno al 16% en pacientes de alto riesgo cardiovascular. Por otra, evaluar su relación con la mortalidad a 30 días y un año; la presencia de LMP se asocia a una mayor mortalidad. ABSTRACT Perioperative myocardial injury in non-cardiac surgery Perioperative myocardial injury (PMI) in non-cardiac surgery is a complication, often not identified, that is related to an increase in mortality at 30 days. The objectives of this study are, on the one hand, to know the incidence of PMI, which is around 16% in patients with a high cardiovascular risk. On the other, evaluate its relationship with mortality at 30 days and one year; the presence of PMI is associated with increased mortality.

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