Home > Riviste > The Journal of Cardiovascular Surgery > Fascicoli precedenti > Articles online first > The Journal of Cardiovascular Surgery 2020 Sep 04

ULTIMO FASCICOLO
 

JOURNAL TOOLS

eTOC
Per abbonarsi
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Publication history
Estratti
Permessi
Per citare questo articolo

 

 

The Journal of Cardiovascular Surgery 2020 Sep 04

DOI: 10.23736/S0021-9509.20.11205-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Myocardial injury after non-cardiac surgery (MINS) in EVAR patients: a retrospective single-centre study

Joel SOUSA 1, 2 , João ROCHA-NEVES 1, 2, José OLIVEIRA-PINTO 1, 2, Armando MANSILHA 1, 2

1 Department of Angiology and Vascular Surgery, Centro Hospitalar de S.João, Porto, Portugal; 2 Department of Physiology and Surgery, Faculty of Medicine of the University of Porto, Porto, Portugal


PDF


BACKGROUND: MINS (myocardial injury after non-cardiac surgery) stands for myocardial injury due to ischemia that occurs during or within 30-days after non-cardiac surgery. Although MINS is known to be independently associated with 30-day mortality after intervention, little is described about the impact of MINS after vascular procedures, particularly after endovascular aneurysm repair (EVAR).
METHODS: Observational, retrospective, single-centre study. All patients undergoing elective standard EVAR between January 2008 and June 2017, and with at least one post-operative measurement of troponin I in the first 48h after surgery, were retrospectively included. MINS was defined as the value exceeding the 99th percentile of a normal reference population with a coefficient of variation<10%. Primary outcomes include the prevalence of MINS in this subset of EVAR patients, as well as its impact in mid-term all-cause mortality. As secondary aim, the preoperative predictors of MINS were also assessed.
RESULTS: One-hundred and thirty six patients with post-operative troponin measurements were included (95.6% male; mean age 75.51years). MINS was diagnosed in 16.2% (n=22) of the patients, and in 86.4% of the cases (n=19) it was completely asymptomatic. Heart failure (31.8% vs 10.5%, P=0.016), ASA score >3 (95.5% vs 67.5%, P=0.004) and pre-operative (P=0.036) and post-operative (P=0.04) hemoglobin concentrations < 12 g/dl were found to be significantly associated with MINS. Regarding remaining baseline characteristics, anesthesia and femoral access, no further differences were observed. Survival at 1, 3 and 5 years was 92% (95% CI 4.6-6.9, standard error (SE) 0.023), 81% (95% CI 5.6-7.6, SE 0.034) and 71% (95% CI 6.9-8.7, SE 0.04), with two deaths reported at 30 days follow-up. MINS was found to be significantly associated with increased mid-term all-cause mortality after EVAR at 24 months follow-up (84.2% ± 3.4% vs 63.6% ± 10.3%,P=0.001), with a 2.12-fold risk increase of death.
CONCLUSIONS: MINS is a common complication after EVAR and negatively impacts the mid-term prognosis of such interventions. In the majority of cases it is asymptomatic and therefore not detectable unless routine post-operative troponin measurements are performed.


KEY WORDS: Abdominal aortic aneurysm; Endovascular aneurysm repair; Myocardial injury after non-cardiac surgery

inizio pagina