Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

Fernando Botto; Pablo Alonso-Coello; Matthew T.V. Chan; Juan Carlos Villar; Denis Xavier; Sadeesh K. Srinathan; Gordon Guyatt; Patricia Cruz; Michelle Graham; C. Y. Wang; Otavio Berwanger; Rupert M. Pearse; Bruce M. Biccard; Valsa Abraham; German Malaga; Graham S. Hillis; Reitze N. Rodseth; Deborah Cook; Carisi A. Polanczyk; Wojciech Szczeklik; Daniel I. Sessler; Tej Sheth; Gareth L. Ackland; Martin Leuwer; Amit X. Garg; Yannick Lemanach; Shirley Pettit; Diane Heels-Ansdell; Giovanna Luratibuse; Michael Walsh; Robert Sapsford; Holger J. Schünemann; Andrea Kurz; Sabu Thomas; Marko Mrkobrada; Lehana Thabane; Hertzel Gerstein; Pilar Paniagua; Peter Nagele; Parminder Raina; Salim Yusuf; P. J. Devereaux; Matthew J. McQueen; Mohit Bhandari; Jackie Bosch; Norman Buckley; Clara K. Chow; Richard Halliwell; Stephen Li; Vincent W. Lee; John Mooney; Mariana V. Furtado; Erica Suzumura; Eliana Santucci; Katia Leite; Jose Amalth Do Espirirto Santo; Cesar A.P. Jardim; Alexandre Biasi Cavalcanti; Helio Penna Guimaraes; Michael J. Jacka; Finlay McAlister; Sean McMurtry; Derek Townsend; Neesh Pannu; Sean Bagshaw; Amal Bessissow; Emmanuelle Duceppe; John Eikelboom; Javier Ganame; James Hankinson; Stephen Hill; Sanjit Jolly; Andre Lamy; Elizabeth Ling; Patrick Magloire; Guillaume Pare; Deven Reddy; David Szalay; Jacques Tittley; Jeff Weitz; Richard Whitlock; Saeed Darvish-Kazim; Justin Debeer; Peter Kavsak; Clive Kearon; Richard Mizera; Martin O'Donnell; Jehonathan Pinthus; Sebastian Ribas; Marko Simunovic; Vikas Tandon; Tomas Vanhelder; Mitchell Winemaker; Sarah McDonald; Paul O'Bryne; Ameen Patel; James Paul; Zubin Punthakee; Karen Raymer; Omid Salehian; Fred Spencer; Stephen Walter; Andrew Worster; Anthony Adili; Catherine Clase; Mark Crowther; James Douketis; Azim Gangji; Paul Jackson; Wendy Lim; Peter Lovrics; Sergio Mazzadi; William Orovan; Jill Rudkowski; Mark Soth; Maria Tiboni; Rey Acedillo; Ainslie Hildebrand; Ngan Lam; Danielle MacNeil; Pavel S. Roshanov; Clare Ramsey; Philip St John; Laurel Thorlacius; Faisal S. Siddiqui; Hilary P. Grocott; Andrew McKay; Trevor W.R. Lee; Ryan Amadeo; Duane Funk; Heather McDonald; James Zacharias; Olga Lucía Cortés; Maria Stella Chaparro; Skarlett Vásquez; Alvaro Castañeda; Silvia Ferreira; Pierre Coriat; Denis Monneret; Jean Pierre Goarin; Cristina Ibanez Esteve; Catherine Royer; Georges Daas; Gordon Y.S. Choi; Tony Gin; Lydia C.W. Lit; Alben Sigamani; Atiya Faruqui; Radhika Dhanpal; Smitha Almeida; Joseph Cherian; Sultana Furruqh; Lalita Afzal; Preetha George; Shaveta Mala; Paola Muti; Enrico Vizza; C. Y. Wang; G. S.Y. Ong; Marzida Mansor; Alvin S.B. Tan; Ina I. Shariffuddin; V. Vasanthan; N. H.M. Hashim; A. Wahab Undok; Ushananthini Ki; Hou Yee Lai; Wan Azman Ahmad; Azad H.A. Razack; Vanessa Valderrama-Victoria; Javier D. Loza-Herrera; Maria De Los Angeles Lazo; Aida Rotta-Rotta; Barbara Sokolowska; Jacek Musial; Jacek Gorka; Pawel Iwaszczuk; Mateusz Kozka; MacIej Chwala; Marcin Raczek; Tomasz Mrowiecki; Bogusz Kaczmarek; Hussein Cassimjee; Dean Gopalan; Theroshnie Kisten; Aine Mugabi; Prebashini Naidoo; Rubeshan Naidoo; David Skinner; Alex Torborg; Gerard Urrutia; Mari Luz Maestre; Miquel Santaló; Raúl Gonzalez; Adrià Font; Cecilia Martínez; Xavier Pelaez; Marta De Antonio; Jose Marcial Villamor; Jesús Álvarez García; Maria José Ferré; Ekaterina Popova; Ignacio Garutti; Carmen Fernández; Maria Palencia; Susana Díaz; Teresa Del Castillo; Alberto Varela; Angeles De Miguel; Manuel Muñoz; Patricia Piñeiro; Gabriel Cusati; Maria Del Barrio; Maria José Membrillo; David Orozco; Fidel Reyes; Robert J. Sapsford; Julian Barth; Julian Scott; Alistair Hall; Simon Howell; Michaela Lobley; Janet Woods; Susannah Howard; Joanne Fletcher; Nikki Dewhirst; C. Williams; A. Rushton; I. Welters; M. Leuwer; Ahsun Khan; Edyta Niebrzegowska; Sally Benton; Andrew Wragg; Andrew Archbold; Amanda Smith; Eleanor McAlees; Cheryl Ramballi; Neil MacDonald; Marta Januszewska; Robert Stephens; Anna Reyes; Laura Gallego Paredes; Pervez Sultan; David Cain; John Whittle; Ana Gutierrez Del Arroyo; Zhuo Sun; Patrick S. Finnegan; Cameron Egan; Hooman Honar; Aram Shahinyan; Krit Panjasawatwong; Alexander Y. Fu; Sihe Wang; Edmunds Reineks; Jane Blood; Megan Kalin; David Gibson; Troy Wildes

doi:10.1097/ALN.0000000000000113

Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

Fernando Botto, Pablo Alonso-Coello, Matthew T.V. Chan, Juan Carlos Villar, Denis Xavier, Sadeesh K. Srinathan, Gordon Guyatt, Patricia Cruz, Michelle Graham, C. Y. Wang, Otavio Berwanger, Rupert M. Pearse, Bruce M. Biccard, Valsa Abraham, German Malaga, Graham S. Hillis, Reitze N. Rodseth, Deborah Cook, Carisi A. Polanczyk, Wojciech SzczeklikDaniel I. Sessler, Tej Sheth, Gareth L. Ackland, Martin Leuwer, Amit X. Garg, Yannick Lemanach, Shirley Pettit, Diane Heels-Ansdell, Giovanna Luratibuse, Michael Walsh, Robert Sapsford, Holger J. Schünemann, Andrea Kurz, Sabu Thomas, Marko Mrkobrada, Lehana Thabane, Hertzel Gerstein, Pilar Paniagua, Peter Nagele, Parminder Raina, Salim Yusuf, P. J. Devereaux, Matthew J. McQueen, Mohit Bhandari, Jackie Bosch, Norman Buckley, Clara K. Chow, Richard Halliwell, Stephen Li, Vincent W. Lee, John Mooney, Mariana V. Furtado, Erica Suzumura, Eliana Santucci, Katia Leite, Jose Amalth Do Espirirto Santo, Cesar A.P. Jardim, Alexandre Biasi Cavalcanti, Helio Penna Guimaraes, Michael J. Jacka, Finlay McAlister, Sean McMurtry, Derek Townsend, Neesh Pannu, Sean Bagshaw, Amal Bessissow, Emmanuelle Duceppe, John Eikelboom, Javier Ganame, James Hankinson, Stephen Hill, Sanjit Jolly, Andre Lamy, Elizabeth Ling, Patrick Magloire, Guillaume Pare, Deven Reddy, David Szalay, Jacques Tittley, Jeff Weitz, Richard Whitlock, Saeed Darvish-Kazim, Justin Debeer, Peter Kavsak, Clive Kearon, Richard Mizera, Martin O'Donnell, Jehonathan Pinthus, Sebastian Ribas, Marko Simunovic, Vikas Tandon, Tomas Vanhelder, Mitchell Winemaker, Sarah McDonald, Paul O'Bryne, Ameen Patel, James Paul, Zubin Punthakee, Karen Raymer, Omid Salehian, Fred Spencer, Stephen Walter, Andrew Worster, Anthony Adili, Catherine Clase, Mark Crowther, James Douketis, Azim Gangji, Paul Jackson, Wendy Lim, Peter Lovrics, Sergio Mazzadi, William Orovan, Jill Rudkowski, Mark Soth, Maria Tiboni, Rey Acedillo, Ainslie Hildebrand, Ngan Lam, Danielle MacNeil, Pavel S. Roshanov, Clare Ramsey, Philip St John, Laurel Thorlacius, Faisal S. Siddiqui, Hilary P. Grocott, Andrew McKay, Trevor W.R. Lee, Ryan Amadeo, Duane Funk, Heather McDonald, James Zacharias, Olga Lucía Cortés, Maria Stella Chaparro, Skarlett Vásquez, Alvaro Castañeda, Silvia Ferreira, Pierre Coriat, Denis Monneret, Jean Pierre Goarin, Cristina Ibanez Esteve, Catherine Royer, Georges Daas, Gordon Y.S. Choi, Tony Gin, Lydia C.W. Lit, Alben Sigamani, Atiya Faruqui, Radhika Dhanpal, Smitha Almeida, Joseph Cherian, Sultana Furruqh, Lalita Afzal, Preetha George, Shaveta Mala, Paola Muti, Enrico Vizza, C. Y. Wang, G. S.Y. Ong, Marzida Mansor, Alvin S.B. Tan, Ina I. Shariffuddin, V. Vasanthan, N. H.M. Hashim, A. Wahab Undok, Ushananthini Ki, Hou Yee Lai, Wan Azman Ahmad, Azad H.A. Razack, Vanessa Valderrama-Victoria, Javier D. Loza-Herrera, Maria De Los Angeles Lazo, Aida Rotta-Rotta, Barbara Sokolowska, Jacek Musial, Jacek Gorka, Pawel Iwaszczuk, Mateusz Kozka, MacIej Chwala, Marcin Raczek, Tomasz Mrowiecki, Bogusz Kaczmarek, Hussein Cassimjee, Dean Gopalan, Theroshnie Kisten, Aine Mugabi, Prebashini Naidoo, Rubeshan Naidoo, David Skinner, Alex Torborg, Gerard Urrutia, Mari Luz Maestre, Miquel Santaló, Raúl Gonzalez, Adrià Font, Cecilia Martínez, Xavier Pelaez, Marta De Antonio, Jose Marcial Villamor, Jesús Álvarez García, Maria José Ferré, Ekaterina Popova, Ignacio Garutti, Carmen Fernández, Maria Palencia, Susana Díaz, Teresa Del Castillo, Alberto Varela, Angeles De Miguel, Manuel Muñoz, Patricia Piñeiro, Gabriel Cusati, Maria Del Barrio, Maria José Membrillo, David Orozco, Fidel Reyes, Robert J. Sapsford, Julian Barth, Julian Scott, Alistair Hall, Simon Howell, Michaela Lobley, Janet Woods, Susannah Howard, Joanne Fletcher, Nikki Dewhirst, C. Williams, A. Rushton, I. Welters, M. Leuwer, Ahsun Khan, Edyta Niebrzegowska, Sally Benton, Andrew Wragg, Andrew Archbold, Amanda Smith, Eleanor McAlees, Cheryl Ramballi, Neil MacDonald, Marta Januszewska, Robert Stephens, Anna Reyes, Laura Gallego Paredes, Pervez Sultan, David Cain, John Whittle, Ana Gutierrez Del Arroyo, Zhuo Sun, Patrick S. Finnegan, Cameron Egan, Hooman Honar, Aram Shahinyan, Krit Panjasawatwong, Alexander Y. Fu, Sihe Wang, Edmunds Reineks, Jane Blood, Megan Kalin, David Gibson, Troy Wildes

Research output: Contribution to journal › Article › peer-review

733 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	564-578
Number of pages	15
Journal	Anesthesiology
Volume	120
Issue number	3
DOIs	https://doi.org/10.1097/ALN.0000000000000113
State	Published - Mar 1 2014
Externally published	Yes

ASJC Scopus subject areas

Anesthesiology and Pain Medicine

Access to Document

10.1097/ALN.0000000000000113

Cite this

Botto, F., Alonso-Coello, P., Chan, M. T. V., Villar, J. C., Xavier, D., Srinathan, S. K., Guyatt, G., Cruz, P., Graham, M., Wang, C. Y., Berwanger, O., Pearse, R. M., Biccard, B. M., Abraham, V., Malaga, G., Hillis, G. S., Rodseth, R. N., Cook, D., Polanczyk, C. A., ... Wildes, T. (2014). Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes. Anesthesiology, 120(3), 564-578. https://doi.org/10.1097/ALN.0000000000000113

Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes. / Botto, Fernando; Alonso-Coello, Pablo; Chan, Matthew T.V. et al.
In: Anesthesiology, Vol. 120, No. 3, 01.03.2014, p. 564-578.

Research output: Contribution to journal › Article › peer-review

Botto, F, Alonso-Coello, P, Chan, MTV, Villar, JC, Xavier, D, Srinathan, SK, Guyatt, G, Cruz, P, Graham, M, Wang, CY, Berwanger, O, Pearse, RM, Biccard, BM, Abraham, V, Malaga, G, Hillis, GS, Rodseth, RN, Cook, D, Polanczyk, CA, Szczeklik, W, Sessler, DI, Sheth, T, Ackland, GL, Leuwer, M, Garg, AX, Lemanach, Y, Pettit, S, Heels-Ansdell, D, Luratibuse, G, Walsh, M, Sapsford, R, Schünemann, HJ, Kurz, A, Thomas, S, Mrkobrada, M, Thabane, L, Gerstein, H, Paniagua, P, Nagele, P, Raina, P, Yusuf, S, Devereaux, PJ, McQueen, MJ, Bhandari, M, Bosch, J, Buckley, N, Chow, CK, Halliwell, R, Li, S, Lee, VW, Mooney, J, Furtado, MV, Suzumura, E, Santucci, E, Leite, K, Santo, JADE, Jardim, CAP, Cavalcanti, AB, Guimaraes, HP, Jacka, MJ, McAlister, F, McMurtry, S, Townsend, D, Pannu, N, Bagshaw, S, Bessissow, A, Duceppe, E, Eikelboom, J, Ganame, J, Hankinson, J, Hill, S, Jolly, S, Lamy, A, Ling, E, Magloire, P, Pare, G, Reddy, D, Szalay, D, Tittley, J, Weitz, J, Whitlock, R, Darvish-Kazim, S, Debeer, J, Kavsak, P, Kearon, C, Mizera, R, O'Donnell, M, Pinthus, J, Ribas, S, Simunovic, M, Tandon, V, Vanhelder, T, Winemaker, M, McDonald, S, O'Bryne, P, Patel, A, Paul, J, Punthakee, Z, Raymer, K, Salehian, O, Spencer, F, Walter, S, Worster, A, Adili, A, Clase, C, Crowther, M, Douketis, J, Gangji, A, Jackson, P, Lim, W, Lovrics, P, Mazzadi, S, Orovan, W, Rudkowski, J, Soth, M, Tiboni, M, Acedillo, R, Hildebrand, A, Lam, N, MacNeil, D, Roshanov, PS, Ramsey, C, John, PS, Thorlacius, L, Siddiqui, FS, Grocott, HP, McKay, A, Lee, TWR, Amadeo, R, Funk, D, McDonald, H, Zacharias, J, Cortés, OL, Chaparro, MS, Vásquez, S, Castañeda, A, Ferreira, S, Coriat, P, Monneret, D, Goarin, JP, Esteve, CI, Royer, C, Daas, G, Choi, GYS, Gin, T, Lit, LCW, Sigamani, A, Faruqui, A, Dhanpal, R, Almeida, S, Cherian, J, Furruqh, S, Afzal, L, George, P, Mala, S, Muti, P, Vizza, E, Wang, CY, Ong, GSY, Mansor, M, Tan, ASB, Shariffuddin, II, Vasanthan, V, Hashim, NHM, Undok, AW, Ki, U, Lai, HY, Ahmad, WA, Razack, AHA, Valderrama-Victoria, V, Loza-Herrera, JD, De Los Angeles Lazo, M, Rotta-Rotta, A, Sokolowska, B, Musial, J, Gorka, J, Iwaszczuk, P, Kozka, M, Chwala, M, Raczek, M, Mrowiecki, T, Kaczmarek, B, Cassimjee, H, Gopalan, D, Kisten, T, Mugabi, A, Naidoo, P, Naidoo, R, Skinner, D, Torborg, A, Urrutia, G, Maestre, ML, Santaló, M, Gonzalez, R, Font, A, Martínez, C, Pelaez, X, De Antonio, M, Villamor, JM, García, JÁ, Ferré, MJ, Popova, E, Garutti, I, Fernández, C, Palencia, M, Díaz, S, Del Castillo, T, Varela, A, De Miguel, A, Muñoz, M, Piñeiro, P, Cusati, G, Del Barrio, M, Membrillo, MJ, Orozco, D, Reyes, F, Sapsford, RJ, Barth, J, Scott, J, Hall, A, Howell, S, Lobley, M, Woods, J, Howard, S, Fletcher, J, Dewhirst, N, Williams, C, Rushton, A, Welters, I, Leuwer, M, Khan, A, Niebrzegowska, E, Benton, S, Wragg, A, Archbold, A, Smith, A, McAlees, E, Ramballi, C, MacDonald, N, Januszewska, M, Stephens, R, Reyes, A, Paredes, LG, Sultan, P, Cain, D, Whittle, J, Del Arroyo, AG, Sun, Z, Finnegan, PS, Egan, C, Honar, H, Shahinyan, A, Panjasawatwong, K, Fu, AY, Wang, S, Reineks, E, Blood, J, Kalin, M, Gibson, D & Wildes, T 2014, 'Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes', Anesthesiology, vol. 120, no. 3, pp. 564-578. https://doi.org/10.1097/ALN.0000000000000113

@article{9322e7f103104b85bb957e03ad07e13c,

title = "Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes",

abstract = "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.",

author = "Fernando Botto and Pablo Alonso-Coello and Chan, {Matthew T.V.} and Villar, {Juan Carlos} and Denis Xavier and Srinathan, {Sadeesh K.} and Gordon Guyatt and Patricia Cruz and Michelle Graham and Wang, {C. Y.} and Otavio Berwanger and Pearse, {Rupert M.} and Biccard, {Bruce M.} and Valsa Abraham and German Malaga and Hillis, {Graham S.} and Rodseth, {Reitze N.} and Deborah Cook and Polanczyk, {Carisi A.} and Wojciech Szczeklik and Sessler, {Daniel I.} and Tej Sheth and Ackland, {Gareth L.} and Martin Leuwer and Garg, {Amit X.} and Yannick Lemanach and Shirley Pettit and Diane Heels-Ansdell and Giovanna Luratibuse and Michael Walsh and Robert Sapsford and Sch{\"u}nemann, {Holger J.} and Andrea Kurz and Sabu Thomas and Marko Mrkobrada and Lehana Thabane and Hertzel Gerstein and Pilar Paniagua and Peter Nagele and Parminder Raina and Salim Yusuf and Devereaux, {P. J.} and McQueen, {Matthew J.} and Mohit Bhandari and Jackie Bosch and Norman Buckley and Chow, {Clara K.} and Richard Halliwell and Stephen Li and Lee, {Vincent W.} and John Mooney and Furtado, {Mariana V.} and Erica Suzumura and Eliana Santucci and Katia Leite and Santo, {Jose Amalth Do Espirirto} and Jardim, {Cesar A.P.} and Cavalcanti, {Alexandre Biasi} and Guimaraes, {Helio Penna} and Jacka, {Michael J.} and Finlay McAlister and Sean McMurtry and Derek Townsend and Neesh Pannu and Sean Bagshaw and Amal Bessissow and Emmanuelle Duceppe and John Eikelboom and Javier Ganame and James Hankinson and Stephen Hill and Sanjit Jolly and Andre Lamy and Elizabeth Ling and Patrick Magloire and Guillaume Pare and Deven Reddy and David Szalay and Jacques Tittley and Jeff Weitz and Richard Whitlock and Saeed Darvish-Kazim and Justin Debeer and Peter Kavsak and Clive Kearon and Richard Mizera and Martin O'Donnell and Jehonathan Pinthus and Sebastian Ribas and Marko Simunovic and Vikas Tandon and Tomas Vanhelder and Mitchell Winemaker and Sarah McDonald and Paul O'Bryne and Ameen Patel and James Paul and Zubin Punthakee and Karen Raymer and Omid Salehian and Fred Spencer and Stephen Walter and Andrew Worster and Anthony Adili and Catherine Clase and Mark Crowther and James Douketis and Azim Gangji and Paul Jackson and Wendy Lim and Peter Lovrics and Sergio Mazzadi and William Orovan and Jill Rudkowski and Mark Soth and Maria Tiboni and Rey Acedillo and Ainslie Hildebrand and Ngan Lam and Danielle MacNeil and Roshanov, {Pavel S.} and Clare Ramsey and John, {Philip St} and Laurel Thorlacius and Siddiqui, {Faisal S.} and Grocott, {Hilary P.} and Andrew McKay and Lee, {Trevor W.R.} and Ryan Amadeo and Duane Funk and Heather McDonald and James Zacharias and Cort{\'e}s, {Olga Luc{\'i}a} and Chaparro, {Maria Stella} and Skarlett V{\'a}squez and Alvaro Casta{\~n}eda and Silvia Ferreira and Pierre Coriat and Denis Monneret and Goarin, {Jean Pierre} and Esteve, {Cristina Ibanez} and Catherine Royer and Georges Daas and Choi, {Gordon Y.S.} and Tony Gin and Lit, {Lydia C.W.} and Alben Sigamani and Atiya Faruqui and Radhika Dhanpal and Smitha Almeida and Joseph Cherian and Sultana Furruqh and Lalita Afzal and Preetha George and Shaveta Mala and Paola Muti and Enrico Vizza and Wang, {C. Y.} and Ong, {G. S.Y.} and Marzida Mansor and Tan, {Alvin S.B.} and Shariffuddin, {Ina I.} and V. Vasanthan and Hashim, {N. H.M.} and Undok, {A. Wahab} and Ushananthini Ki and Lai, {Hou Yee} and Ahmad, {Wan Azman} and Razack, {Azad H.A.} and Vanessa Valderrama-Victoria and Loza-Herrera, {Javier D.} and {De Los Angeles Lazo}, Maria and Aida Rotta-Rotta and Barbara Sokolowska and Jacek Musial and Jacek Gorka and Pawel Iwaszczuk and Mateusz Kozka and MacIej Chwala and Marcin Raczek and Tomasz Mrowiecki and Bogusz Kaczmarek and Hussein Cassimjee and Dean Gopalan and Theroshnie Kisten and Aine Mugabi and Prebashini Naidoo and Rubeshan Naidoo and David Skinner and Alex Torborg and Gerard Urrutia and Maestre, {Mari Luz} and Miquel Santal{\'o} and Ra{\'u}l Gonzalez and Adri{\`a} Font and Cecilia Mart{\'i}nez and Xavier Pelaez and {De Antonio}, Marta and Villamor, {Jose Marcial} and Garc{\'i}a, {Jes{\'u}s {\'A}lvarez} and Ferr{\'e}, {Maria Jos{\'e}} and Ekaterina Popova and Ignacio Garutti and Carmen Fern{\'a}ndez and Maria Palencia and Susana D{\'i}az and {Del Castillo}, Teresa and Alberto Varela and {De Miguel}, Angeles and Manuel Mu{\~n}oz and Patricia Pi{\~n}eiro and Gabriel Cusati and {Del Barrio}, Maria and Membrillo, {Maria Jos{\'e}} and David Orozco and Fidel Reyes and Sapsford, {Robert J.} and Julian Barth and Julian Scott and Alistair Hall and Simon Howell and Michaela Lobley and Janet Woods and Susannah Howard and Joanne Fletcher and Nikki Dewhirst and C. Williams and A. Rushton and I. Welters and M. Leuwer and Ahsun Khan and Edyta Niebrzegowska and Sally Benton and Andrew Wragg and Andrew Archbold and Amanda Smith and Eleanor McAlees and Cheryl Ramballi and Neil MacDonald and Marta Januszewska and Robert Stephens and Anna Reyes and Paredes, {Laura Gallego} and Pervez Sultan and David Cain and John Whittle and {Del Arroyo}, {Ana Gutierrez} and Zhuo Sun and Finnegan, {Patrick S.} and Cameron Egan and Hooman Honar and Aram Shahinyan and Krit Panjasawatwong and Fu, {Alexander Y.} and Sihe Wang and Edmunds Reineks and Jane Blood and Megan Kalin and David Gibson and Troy Wildes",

year = "2014",

month = mar,

day = "1",

doi = "10.1097/ALN.0000000000000113",

language = "English (US)",

volume = "120",

pages = "564--578",

journal = "Anesthesiology",

issn = "0003-3022",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

TY - JOUR

T1 - Myocardial Injury after Noncardiac Surgery

T2 - A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

AU - Botto, Fernando

AU - Alonso-Coello, Pablo

AU - Chan, Matthew T.V.

AU - Villar, Juan Carlos

AU - Xavier, Denis

AU - Srinathan, Sadeesh K.

AU - Guyatt, Gordon

AU - Cruz, Patricia

AU - Graham, Michelle

AU - Wang, C. Y.

AU - Berwanger, Otavio

AU - Pearse, Rupert M.

AU - Biccard, Bruce M.

AU - Abraham, Valsa

AU - Malaga, German

AU - Hillis, Graham S.

AU - Rodseth, Reitze N.

AU - Cook, Deborah

AU - Polanczyk, Carisi A.

AU - Szczeklik, Wojciech

AU - Sessler, Daniel I.

AU - Sheth, Tej

AU - Ackland, Gareth L.

AU - Leuwer, Martin

AU - Garg, Amit X.

AU - Lemanach, Yannick

AU - Pettit, Shirley

AU - Heels-Ansdell, Diane

AU - Luratibuse, Giovanna

AU - Walsh, Michael

AU - Sapsford, Robert

AU - Schünemann, Holger J.

AU - Kurz, Andrea

AU - Thomas, Sabu

AU - Mrkobrada, Marko

AU - Thabane, Lehana

AU - Gerstein, Hertzel

AU - Paniagua, Pilar

AU - Nagele, Peter

AU - Raina, Parminder

AU - Yusuf, Salim

AU - Devereaux, P. J.

AU - McQueen, Matthew J.

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AU - Wildes, Troy

PY - 2014/3/1

Y1 - 2014/3/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84895432300&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84895432300&partnerID=8YFLogxK

U2 - 10.1097/ALN.0000000000000113

DO - 10.1097/ALN.0000000000000113

M3 - Article

C2 - 24534856

AN - SCOPUS:84895432300

SN - 0003-3022

VL - 120

SP - 564

EP - 578

JO - Anesthesiology

JF - Anesthesiology

IS - 3

ER -

Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

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