Jacek Górka1, Kamil Polok2, Jakub Fronczek2, Karolina Górka3, Mateusz Kózka4, Paweł Iwaszczuk5, Marzena Frołow5, P J Devereaux6, Bruce Biccard7, Jacek Musiał5, Wojciech Szczeklik8. 1. Department of Intensive Care and Peri-operative Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Medicine, Jagiellonian University Medical College, Kraków, Poland. Electronic address: gorkajacek1@gmail.com. 2. Department of Intensive Care and Peri-operative Medicine, Jagiellonian University Medical College, Kraków, Poland. 3. Department of Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland. 4. Vascular Surgery Department, Merciful Brothers St. John Grande Hospital, Kraków, Poland. 5. Department of Medicine, Jagiellonian University Medical College, Kraków, Poland. 6. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada. 7. Department of Anaesthesia and Perioperative Medicine, University of Cape Town and New Groote Schuur Hospital, Cape Town, South Africa. 8. Department of Intensive Care and Peri-operative Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Medicine, Jagiellonian University Medical College, Kraków, Poland.
Abstract
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.
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.
Authors: Marco Alfonso Perrone; Alberto Aimo; Sergio Bernardini; Aldo Clerico Journal: Int J Environ Res Public Health Date: 2022-04-24 Impact factor: 4.614