Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

TY - JOUR

T1 - Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome

AU - du Fay de Lavallaz, Jeanne

AU - Puelacher, Christian

AU - Lurati Buse, Giovanna

AU - Bolliger, Daniel

AU - Germanier, Dominic

AU - Hidvegi, Reka

AU - Walter, Joan Elias

AU - Twerenbold, Raphael

AU - Strebel, Ivo

AU - Badertscher, Patrick

AU - Sazgary, Lorraine

AU - Lampart, Andreas

AU - Espinola, Jaqueline

AU - Kindler, Christoph

AU - Hammerer-Lercher, Angelika

AU - Thambipillai, Saranya

AU - Guerke, Lorenz

AU - Rentsch, Katharina

AU - Buser, Andreas

AU - Gualandro, Danielle

AU - Jakob, Marcel

AU - Mueller, Christian

AU - BASEL-PMI Investigators

N1 - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/6

Y1 - 2019/6

N2 - OBJECTIVE: Recently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.METHODS: In a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score-matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.RESULTS: Of 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).CONCLUSIONS: Although there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.CLINICAL TRIAL REGISTRATION: NCT02573532;Results.

AB - OBJECTIVE: Recently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.METHODS: In a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score-matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.RESULTS: Of 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).CONCLUSIONS: Although there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.CLINICAL TRIAL REGISTRATION: NCT02573532;Results.

KW - Aged

KW - Biomarkers/blood

KW - C-Reactive Protein/metabolism

KW - Circadian Rhythm/physiology

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Incidence

KW - Male

KW - Myocardial Infarction/blood

KW - Preoperative Period

KW - Prognosis

KW - Propensity Score

KW - Prospective Studies

KW - Surgical Procedures, Operative

KW - Switzerland/epidemiology

KW - Troponin T/blood

U2 - 10.1136/heartjnl-2018-313876

DO - 10.1136/heartjnl-2018-313876

M3 - SCORING: Journal article

C2 - 30541757

VL - 105

SP - 826

EP - 833

JO - HEART

JF - HEART

SN - 1355-6037

IS - 11

ER -