Prognostic value of preoperative electrocardiography in predicting myocardial injury after vascular surgery.

BACKGROUND: The current European guidelines recommend that a preoperative electrocardiogram (ECG) should be performed routinely in patients scheduled for high-risk surgery. However, the evidence regarding ECG as a predictor of perioperative cardiac complications is weak. AIM: To evaluate the association of preoperative ECG with short- and long-term outcomes in patients undergoing high-risk vascular procedures. METHODS: This was a substudy of the international Vascular events In noncardiac Surgery patIents cohort evaluatioN (VISION) Study and included consecutive patients undergoing vascular procedures in a single tertiary center. In each patient, a preoperative 12-lead ECG was evaluated by two experienced clinicians following the Polish Cardiac Society recommendations. We performed routine perioperative troponin monitoring at five time points (one preoperative and four postoperative measurements) to evaluate whether preoperative ECG abnormalities are associated with myocardial injury after noncardiac surgery (MINS) and 1-year major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, and stroke. RESULTS: The study group comprised 348 patients, 80.5% of whom were male and the median age (interquartile range [IQR]) was 65 (59-72) years. The incidence of MINS and 1-year MACE was 18.7% and 14.4%, respectively. Multivariable analysis showed that none of the predefined ECG abnormalities (ST depression, left axis deviation, atrial fibrillation, and bundle branch block) was associated with the incidence of MINS or 1-year MACE. CONCLUSION: This study confirmed that preoperative ECG abnormalities are frequent in patients undergoing high-risk vascular surgery. However, we did not find evidence supporting the relation between preoperative ECG abnormalities and postoperative adverse cardiac outcomes in high-risk patients.

Prevalence of Renal Masses Suspected of Malignancy and Adrenal Incidentalomas in Patients With Abdominal Aortic Aneurysm.

OBJECTIVE: The aim of our study was to assess the prevalence of renal masses suspected of malignancy and adrenal incidentalomas in patients with abdominal aortic aneurysm based on the computed tomography angiography (CTA). METHODS: In the retrospective cross-sectional study, the CTA scans of patients with abdominal aortic aneurysms and thoraco-abdominal aortic aneurysms type II-IV were assessed. Patients with thoraco-abdominal aortic aneurysms type I and V and history of abdominal aortic surgery were excluded from the study. RESULTS: Study group comprised 937 patients with a median age of 73.0 years, 83.8% of whom were male. CTA revealed renal tumors in 11 patients (1.2% of the study population) with a median size of 26 mm (interquartile range 20-50). Adrenal incidentalomas were found in 61 patients (6.5% of the study population). In 20 patients (2.1%) adrenal lesions were found bilaterally. CONCLUSION: In the described cohort, the renal and adrenal tumors were relatively common findings among patients with abdominal aortic aneurysm and thoraco-abdominal aortic aneurysms type II-IV. Both anaesthesiologists and surgeons should be vigilant about the possibility of such coexistence in order to provide the patients with the best possible perioperative care and an optimal surgical modality.

Myocardial Injury is More Common than Deep Venous Thrombosis after Vascular Surgery and is Associated with a High One Year Mortality Risk.

OBJECTIVE/BACKGROUND: Venous thromboembolism (VTE) has been considered the dominant major life threatening vascular complication after non-cardiac surgery, but recent studies have shifted the emphasis toward myocardial injury after non-cardiac surgery (MINS) as a common adverse event in the peri-operative setting. The aim of the present study was to compare the incidence and influence on mortality of two dominant venous and arterial events in the peri-operative period by prospectively screening a consecutive cohort of patients undergoing vascular surgery. METHODS: This was a sub-study of Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION), the main objective of which was to evaluate major peri-operative complications after non-cardiac surgery. Patients undergoing vascular surgery had their blood collected to measure the Roche fifth generation high sensitivity troponin T (hsTnT) assay before and four times after surgery (6-12 h post-operatively, on the first, second, and third day following the procedure). MINS was defined as an elevated post-operative hsTnT ≥65 ng/L or an hsTnT ≥20 to <65 ng/L with an absolute change of ≥5 ng/L that was judged to be due to ischaemia. All patients underwent ultrasound venous compression testing for deep vein thrombosis (DVT) before, 4, and 7 days after surgery and follow-up was performed by telephone 30 days and 1 year after surgery. RESULTS: In total, 164 consecutive patients were included in this sub-study. MINS was diagnosed in 39 patients (23.8%) and DVT in four patients (2.4%). The 1 year mortality was higher in MINS (9/39 [23.1%]) than non-MINS patients (9/125 [7.2%]; p = .006). None of the patients who developed DVT died in the first year after surgery. CONCLUSION: MINS is a common complication after vascular surgery. It occurs more frequently than DVT and is associated with high 1 year mortality.

The impact of weather factors, moon phases, and seasons on abdominal aortic aneurysm rupture.

BACKGROUND: Several studies have documented that weather factors, seasons of the year, time of the day, and even changes in moon phases have an impact on the occurrence of rupture of an abdominal aortic aneurysm (RAAA); however, the available data are confounding. The objective of this study was to determine the impact of these factors on the prevalence and mortality rate of RAAA. METHODS: This is a retrospective analysis of medical records of patients treated for RAAA over a 10-year period. Weather data (i.e., atmospheric pressure, air temperature, humidity, visibility, and wind speed) and weather events (i.e., rain, snow, and storms, etc) were obtained from the local meteorologic weather station and analyzed for a correlation with RAAA. RESULTS: Five hundred thirty patients with RAAA were identified, and these patients presented on 478 days during the 10-year study period (3,652 days), with the overall in-hospital mortality rate of 48.7%. The RAAA mortality was higher during weekends and national holidays, when compared to weekdays (59% vs 45%; P = 0.006) and in patients admitted between 3-7 am when compared to work day hours (65.5% vs 44.1%; P = 0.035). Season changes had no influence on the frequency of RAAA; however, summer seemed to be associated with an increase in mortality as opposed to autumn (54.4% vs 42.5%; P = 0.047). Mean atmospheric pressure (and fluctuations thereof) and other weather factors, including phases and parts of the moon, did not correlate with RAAA occurrence or its mortality. CONCLUSIONS: Patients with RAAA who were admitted on weekends, national holidays and in late night hours had lower survival rates. Weather factors (including atmospheric pressure) do not influence the prevalence and mortality of RAAA.

[Effective application of therapeutic plasma exchange in a case of acute dermatomyositis]. / Skuteczne zastosowanie terapeutycznej wymiany osocza u chorego na ostra postac zapalenia skórno-miesniowego.

We present a case of 22-year-old male with acute dermatomyositis who did not respond to a standard immunosuppressive therapy. Due to rapidly deteriorating clinical status a series of plasmapheresis was performed subsequent to which a quick clinical improvement was observed.