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Featured Studies

Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: A cohort study

Devereaux PJ, Xavier D, Pogue J, et al. Ann Intern Med. 2011;154:523-528

The long-term impact of early cardiovascular therapy intensification for postoperative troponin elevation after major vascular surgery

Foucrier A, Rodseth R, Aissaoui M, et al. Anesth Analg. 2014;119:1053-1063

Examined a cohort of 667 consecutive major vascular surgery patients with an elevated postoperative Troponin I level to determine which patients received medical therapy as per the 2007 American College of Cardiology/American Heart Association recommendations for the medical management of patients with chronic stable angina.
The relationship of medical management consistent with guidelines with 12-month survival without a major cardiac event (ie, death, myocardial infarction, coronary revascularization, or pulmonary edema requiring hospitalization) was examined.

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.
In contrast, patients with a Troponin I elevation who received intensified cardiovascular treatment had an HR of 0.63 (95% CI, 0.10–1.19; P = 0.45) for the primary outcome as compared with the control group.
In patients with elevated Troponin I levels after non-cardiac surgery, long-term adverse cardiac outcomes are likely improved by following evidence-based recommendations for the medical management of acute coronary syndromes, though investigators concluded that this effect needed to be confirmed in a large, randomized, controlled trial.

New

P.J. Devereaux, MD, PhD

Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial

Devereaux PJ, Duceppe E, Guyatt G, et al on behalf of the MANAGE Invesitgators. Lancet 2018; 391:2325–2334

MANAGE trial is an international, multicenter, randomized controlled trial with partial 2x2 factorial design involving 84 centers in 19 countries.
Participants aged ≥45 who underwent noncardiac surgery and sustained a myocardial infarction after noncardiac surgery (MINS) were included in the trial.
The study randomized 1754 patients to dabigatran or placebo and 556 patients were randomized to omeprazole or placebo.

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.
MANAGE demonstrated that the use of dabigatran could prevent major vascular complications with no observed increased risk of major bleeding.

Cardiac Complications in Patients Undergoing Major Noncardiac Surgery.

Devereaux PJ, Sessler DI. N Engl J Med. 2015;373:2258-2269. doi: 10.1056/NEJMra1502824

Canadian Cardiovascular Society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery

Duceppe E, Parlow J, MacDonald P, et al. Can J Cardiol. 2016 Oct 4. pii: S0828-282X(16)30980-1. doi: 10.1016/j.cjca.2016.09.008

Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery

Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators, Devereaux PJ, Chan MT, et al. JAMA. 2012;307:2295-304