Key Findings

PODCAST

New

A challenge to RAM is regional connectivity. Connectivity issues are predominant in remote and densely populated areas where cellular reception is subjected to available infrastructure.
Key to the optimal design of future RAM trials is the acquisition of big data through large-scale, prospective, observational studies and adequately powered RCT’s with selective deployment of RAM, incorporation of biomarkers and machine learning.

Compared to placebo, the use of dabigatran reduced major vascular complications (ie, a composite of vascular mortality, nonfatal MI, non-hemorrhagic stroke, peripheral arterial thrombosis, amputation, and symptomatic VTE) by a hazard ratio of 0.72.
In terms of primary safety outcome (i.e. a composite of life-threatening, major, and critical organ bleed), there was no significant difference between dabigatran and placebo.

In the aspirin group, there was a significant reduction in the composite outcome of death and MI (HR 0.50) and MI alone (HR 0.44).
There was no significant difference in the incidence of major bleeding between the two groups.
This study demonstrated that among patients with prior PCI undergoing noncardiac surgery, perioperative aspirin may be more likely to be beneficial in this subgroup.

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.

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.

Compared with the revised cardiac risk index alone, findings on preoperative CCTA appropriately improved risk estimation among patients who will experience perioperative cardiovascular death or a myocardial infarction (adjusted hazard ratio for extensive obstructive coronary artery disease, 3.76; 95% confidence interval [CI], 1.12 to 12.62).

The overall incidence of the composite of death and non-fatal myocardial infarction at 30 days was 10.8% (235 events).
NP threshold values associated with lowest p value for death and myocardial infarction for BNP was 92 ng/L and for NT-proBNP was 300 ng/L.
The incidence of death and non-fatal myocardial infarction at 30 days was 21.8% in patients who had a positive preoperative NT-proBNP (≥300 ng/L ) or BNP (≥92 ng/L), compared to 4.9% in patients who had a negative preoperative NT-proBNP (<300 ng/L) or BNP (<92 ng/L).

Therapy was intensified in 43 of 66 patients (65%) who suffered a Troponin I elevation after surgery.
Patients with a Troponin I elevation who did not receive intensified cardiovascular treatment had a hazard ratio (HR) of 1.77 (95% confidence interval (CI), 1.13–2.42; P = 0.004) for the primary study outcome as compared with the control group.

Clonidine had no effect on death or myocardial infarction. Clonidine was associated with an increased risk of non-fatal cardiac arrest and hypotension.
ASA had no effect on death or myocardial infarction, but increased the risk of major and life-threatening bleeding.
POISE 2 demonstrated that clinicians can improve outcomes by holding ASA during the perioperative period.
Perioperative hypotension and major/life threatening bleeding were independent predictors of perioperative myocardial infarction.