Characteristics and short-term prognosis of perioperative myocardialinfarction in patients undergoing noncardiac surgery a cohort study
Ann Intern Med
; 154(8): 523-528, 2011. ilus, tab
Artigo
em Inglês
| Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1059676
Biblioteca responsável:
BR79.1
Localização: 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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Coleções:
Bases de dados nacionais
/
Brasil
Base de dados:
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Assunto principal:
Prognóstico
/
Cuidados Pré-Operatórios
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Infarto do Miocárdio
Tipo de estudo:
Estudo de etiologia
/
Estudo observacional
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Estudo prognóstico
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Fatores de risco
Idioma:
Inglês
Revista:
Ann Intern Med
Ano de publicação:
2011
Tipo de documento:
Artigo
Instituição/País de afiliação:
Anshan Iron and Steel Mining Company Hospital Gongchangling/CN
/
Centre Hospitalier Universitaire de Sherbrooke/CA
/
Department of Anesthesiology, The Ottawa Hospital/CA
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Department of Clinical Epidemiology and Biostatistics/CA
/
Division of Clinical Trials/IN
/
Division of Clinical Trials, St. Johns Research Institute/IN
/
Hospital General Gregorio Maranõn/ES
/
Instituto Dante Pazzanese de Cardiologia/BR
/
Population Health Research Institute/CA
/
Royal Melbourne Hospital/AU