REDUCING GLOBAL PERIOPERATIVE RISK
This resource center is jointly hosted by The American Journal of Medicine,
The American Journal of Cardiology, and the Canadian Journal of Cardiology.
Risk Identification
Featured Study
Key Highlights
- The VISION Study (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation) is a prospective multicenter international cohort study.
- Main study objectives included evaluation of perioperative vascular complications in patients >45 years of age undergoing non-cardiac surgery. The study also assessed the value of routine Troponin (T) measurement for detection of myocardial injury after non-cardiac surgery (MINS) and adverse event prognostication.
- The study recruited 40,000 patients at 28 sites in 15 countries in North and South America, Europe, Asia, Africa, Australia. Patients were recruited consecutively between August 6, 2007 and January 11, 2011.
Key Findings
- Among the first 15,000 patients who had fourth-generation Troponin T (TnT) measured, the peak postoperative TnT measurement during the first 3 days after surgery was significantly associated with 30-day mortality.
- MINS occurred in 8% of the study population, and 85% of MINS would have been missed without perioperative troponin monitoring.
- Post-op variables predicting death at 30 days after surgery included MINS [(TnT ≥0.03) Adjusted HR (95% CI) 3.87 (2.96-5.08)], Sepsis [Adjusted HR (95% CI) 7.18 (5.17-9.97)], Stroke [Adjusted HR (95% CI) 3.50 (2.05-5.97)], and PE [Adjusted HR (95% CI) 6.11 (3.18-11.74)].
Featured Articles
Suggested Readings
Weiser TG, Regenbogen SE, Thompson KD, et al. Lancet. 2008;372:139-144
Devereaux PJ, Yang H, Yusuf S, et al. Lancet. 2008;371:1839-1847
Gordon HS, Johnson ML, Wray NP, et al. Med Care. 2005;43(2):159-167
Key Highlights
- The VISION Study (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation) was a prospective multicenter international cohort study. Main study objectives included evaluation of perioperative vascular complications in patients >45 years of age undergoing non-cardiac surgery. The study also assessed the value of routine high-sensitivity Troponin T (hsTnT) measurement for detection of myocardial injury after non-cardiac surgery (MINS) and adverse event prognostication.
- The study recruited 40,000 patients at 28 sites in 15 countries in North and South America, Europe, Asia, Africa, Australia. Patients were recruited consecutively between August 6, 2007 and January 11, 2011.
Key Findings
- Among 21,842 patients underwent noncardiac surgery and who had hsTnT measured, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.
- Multivariable analysis demonstrated that compared with the reference group (peak hsTnT <5 ng/L), peak postoperative hsTnT levels of 20 to <65 ng/L, 65 to <1000 ng/L, and ≥1000 ng/L had 30-day mortality rates of 3.0%(123/4049; 95%CI, 2.6%-3.6%), 9.1% (102/1118; 95%CI, 7.6%-11.0%), and 29.6%(16/54; 95%CI, 19.1%-42.8%), with corresponding adjusted HRs of 23.63 (95%CI, 10.32-54.09), 70.34 (95% CI, 30.60-161.71), and 227.01 (95%CI, 87.35-589.92), respectively.
- An absolute hsTnT change of ≥5 ng/L was associated with an increased risk of 30-day mortality (adjusted HR, 4.69; 95%CI, 3.52-6.25). An elevated postoperative hsTnT (ie, 20 to <65 ng/L with an absolute change ≥5 ng/L or hsTnT ≥65 ng/L) without an ischemic feature was associated with 30-day mortality (adjusted HR, 3.20; 95%CI, 2.37-4.32).
- Among the 3904 patients (17.9%; 95%CI, 17.4%-18.4%) with MINS, 3633 (93.1%; 95%CI, 92.2%-93.8%) did not experience an ischemic symptom.
Featured Articles
Suggested Readings
Devereaux PJ, Xavier D, Pogue J, et al. Ann Intern Med. 2011;154(8):523-528
Giannitsis E, Kurz K, Hallermayer K, et al. Clin Chem. 2010;56:254-261
