Patient Selection for Routine Troponin Monitoring After Noncardiac Surgery
| Autor: | Remco B. Grobben, Wilton A. van Klei, Judith A. R. van Waes, Hendrik M. Nathoe, Corien S. A. Weersink |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Myocardial ischemia Epidemiology Myocardial Infarction noncardiac surgery 030204 cardiovascular system & hematology Cohort Studies 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors 030202 anesthesiology Internal medicine Clinical Studies medicine Humans Myocardial infarction Selection (genetic algorithm) Original Research Aged Monitoring Physiologic biology troponin business.industry Patient Selection Troponin I Perioperative medicine.disease Troponin myocardial ischemia Elective Surgical Procedures biology.protein Cardiology Female Cardiology and Cardiovascular Medicine business Complication Noncardiac surgery |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| ISSN: | 2047-9980 |
| DOI: | 10.1161/jaha.120.019912 |
| Popis: | Background Myocardial infarction is an important complication after noncardiac surgery. Therefore, perioperative troponin surveillance is recommended for patients at risk. The aim of this study was to identify patients at high risk of perioperative myocardial infarction (POMI), in order to aid appropriate selection and to omit redundant laboratory measurements in patients at low risk. Methods and Results This observational cohort study included patients ≥60 years of age who underwent intermediate to high risk noncardiac surgery. Routine postoperative troponin I monitoring was performed. The primary outcome was POMI. Classification and regression tree analysis was used to identify patient groups with varying risks of POMI. In each subgroup, the number needed to screen to identify 1 patient with POMI was calculated. POMI occurred in 216 (4%) patients and other myocardial injury in 842 (15%) of the 5590 included patients. Classification and regression tree analysis divided patients into 14 subgroups in which the risk of POMI ranged from 1.7% to 42%. Using a risk of POMI ≥2% to select patients for routine troponin I monitoring, this monitoring would be advocated in patients ≥60 years of age undergoing emergency surgery, or those undergoing elective surgery with a Revised Cardiac Risk Index class >2 (ie >1 risk factor). The number needed to screen to detect a patient with POMI would be 14 (95% CI 14–14) and 26% of patients with POMI would be missed. Conclusions To improve selection of high‐risk patients ≥60 years of age, routine postoperative troponin I monitoring could be considered in patients undergoing emergency surgery, or in patients undergoing elective surgery classified as having a revised cardiac risk index class >2. |
| Databáze: | OpenAIRE |
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