Journal ArticleDOI
Impact of haemoglobin concentration on cardiovascular outcome after vascular surgery: a retrospective observational cohort study.
Tabita M. Valentijn,Sanne E. Hoeks,Kelsey A. Martienus,Erik Jan Bakker,Koen M. van de Luijtgaarden,Hence J.M. Verhagen,Robert Jan Stolker,Felix van Lier +7 more
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Pre and postoperative Hb concentrations and Hb decrease are all related to 30-day cardiovascular events in elective vascular surgery patients and are the strongest predictor of 30- day cardiovascular events.Abstract:
Background Although low preoperative haemoglobin (Hb) concentration is a well known risk factor for adverse outcome, little is known about decreases in Hb and postoperative Hb concentrations. Objectives The aim of this study was to evaluate the prognostic impact of both pre- and postoperative Hb concentrations (divided into low, intermediate and high tertiles) as well as Hb decrease, defined as preoperative minus postoperative Hb (g dl(-1)), on postoperative cardiovascular events in vascular surgery patients. Design A retrospective observational cohort study. Setting Erasmus University Medical Centre, Rotterdam, the Netherlands, from 1 January 2002 to 31 December 2011. Patients One thousand four hundred and eighty-four patients underwent elective open or endovascular abdominal aortic repair (aneurysm or stenosis), lower extremity arterial repair or carotid surgery. Patients for whom pre or postoperative Hb concentrations were not available were excluded. Main outcome measures The study endpoint was 30-day postoperative cardiovascular events, including myocardial infarction, heart failure, arrhythmias, stroke, asymptomatic troponin-T release and cardiovascular death. Results In 1041 patients, both pre and postoperative Hb concentrations were available. Thirty-day cardiovascular events occurred in 221 (21%) patients. Multivariable logistic regression analyses, adjusting for age, sex, Revised Cardiac Risk Index (high-risk surgery, coronary heart disease, heart failure, cerebrovascular disease, diabetes mellitus, renal insufficiency), hypertension and hypercholesterolaemia, demonstrated that low preoperative Hb (8.7 to 12.9 g dl(-1)) was associated with 30-day events [odds ratio (OR) 1.7; 95% confidence interval (CI) 1.1 to 2.5]. Intermediate (10.6 to 12.1 g dl(-1)) and low (7.4 to 10.5 g dl(-1)) postoperative Hb and Hb decrease were also associated with an independently increased risk of 30-day events (intermediate Hb: OR 1.7; 95% CI 1.1 to 2.7; low Hb: OR 3.1; 95% CI 2.0 to 4.8; and Hb decrease: OR 1.2; 95% CI 1.1 to 1.3, respectively). Sensitivity analyses excluding patients with transfusions (n=314) demonstrated that only postoperative Hb concentrations remained associated with a high risk of 30-day cardiovascular events (intermediate Hb: OR 1.8; 95% CI 1.0 to 3.3 and low Hb: OR 2.0; 95% CI 1.0 to 4.0). Conclusion Pre and postoperative Hb concentrations and Hb decrease are all related to 30-day cardiovascular events in elective vascular surgery patients. Postoperative Hb concentrations are the strongest predictor of 30-day cardiovascular events.read more
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Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis
TL;DR: Evidence is provided that supports troponin monitoring as a cardiovascular risk stratification tool and postoperative myocardial injury is an independent predictor of major adverse cardiac events and mortality within 30 days and 1 yr after non-cardiac, non-vascular surgery.
Cardiac Troponins Used as Diagnostic and Prognostic Tests in Patients With Kidney Disease
Erin D. Michos,Zackary Berger,Hsin Chieh Yeh,Catalina Suarez-Cuervo,Lisa M Wilson,Sylvie Stacy,Eric B Bass +6 more
TL;DR: Some of the newer highsensitivity assays may be able to measure troponin in normal individuals; although many of the commercially available assays cannot detect Troponin at all or cannot quantify it at levels below the measuring range of the assay.
Journal ArticleDOI
The Impact of Perioperative Red Blood Cell Transfusions on Postoperative Outcomes in Vascular Surgery Patients
Tabita M. Valentijn,Sanne E. Hoeks,Erik Jan Bakker,Koen M. van de Luijtgaarden,Hence J.M. Verhagen,Robert Jan Stolker,Felix van Lier +6 more
TL;DR: Perioperative transfusion is associated with a strongly increased risk of both 30-day CV events and mortality in elective vascular surgery patients.
Journal ArticleDOI
Causes and prevention of postoperative myocardial injury.
Laura Verbree-Willemsen,Remco B. Grobben,Judith A. R. van Waes,Linda M. Peelen,Hendrik M. Nathoe,Wilton A. van Klei,Diederick E. Grobbee +6 more
TL;DR: Better preoperative identification of patients at risk of postoperative myocardial injury, for example using preoperatively measured biomarkers, would be helpful to improve cardiac optimisation.
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Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery
Thomas H. Lee,Edward R. Marcantonio,Carol M. Mangione,Eric J. Thomas,Carisi Anne Polanczyk,E. F. Cook,D. J. Sugarbaker,M. C. Donaldson,Robert Poss,Kalon K.L. Ho,L. E. Ludwig,A. Pedan,Lee Goldman +12 more
TL;DR: In stable patients undergoing nonurgent major noncardiac surgery, this index can identify patients at higher risk for complications and may be useful for identification of candidates for further risk stratification with noninvasive technologies or other management strategies.
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