Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome
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Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome. / BASEL-PMI Investigators.
In: HEART, Vol. 105, No. 11, 06.2019, p. 826-833.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -