Myocardial Injury After Noncardiac Surgery
CA-3 · II.D.1.a.3.a I.A.1.a.3
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In patients with myocardial injury after noncardiac surgery, dabigatran 110 mg twice daily reduced major vascular complications from 15% to 11% with no significant increase in major bleeding.
PMID 29900874
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A peak postoperative high-sensitivity troponin T of 20 to under 65 ng/L with a rise of at least 5 ng/L, or 65 ng/L and above, predicts 30-day mortality even with no ischaemic symptom or ECG change — and 93% of these patients had no symptom at all.
PMID 28444280
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Maximum intraoperative heart rate >100 bpm is associated with increased risk of myocardial injury, myocardial infarction, and mortality after noncardiac surgery.
PMID 29077608
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Many determinants of myocardial injury after noncardiac surgery, such as pre-existing coronary disease, cannot be changed; haemodynamic control, oxygen supply and metabolic homeostasis are the modifiable ones to act on.
PMID 36931053
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Diagnostic thresholds are assay-specific: with the Abbott high-sensitivity troponin I assay, a peak of 60 ng/L or above carried more than a seven-fold increase in major cardiac events and death at 30 days.
PMID 36682485
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With the ADVIA Centaur high-sensitivity troponin I assay a peak of 75 ng/L or above carried a more than five-fold increase in 30-day major cardiovascular events, and predicted them whether or not ischaemic features were present.
PMID 36762424
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