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Intraoperative hypotension is associated with myocardial damage in noncardiac surgery: An observational study
Linn Hallqvist1, Johan Mårtensson, Fredrik Granath
1From the Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital, Solna (LH); Department of Intensive Care, Austin Hospital, Melbourne, Australia, and Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital, Solna (JM); Clinical Epidemiology Unit at Karolinska University Hospital (FG); National Heart Singapore, and Department of Cardiovascular Medicine, Karolinska University Hospital, Huddinge (AS); and Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital, Solna (MB).
Background:
Perioperative myocardial damage and infarction (MI) is associated with increased mortality and other postoperative complications.
Objectives:
To assess the incidence of perioperative myocardial damage in patients undergoing major elective noncardiac surgery, to elucidate any association with postoperative MI and mortality and to estimate the impact of preoperative risk factors and intraoperative hypotension.
Design:
Observational cohort study.
Setting:
Karolinska University Hospital, Stockholm, Sweden, from October 2012 to May 2013.
Patients:
In this single-centre study, all adult patients undergoing major elective noncardiac surgery who were scheduled for an overnight admission to the postoperative unit were included. Patients undergoing phaeochromocytoma surgery were excluded. Preoperative risk factors (co-morbidities), intraoperative events (hypotension defined as a 50% decrease in SBP relative to each patient's baseline and lasting >5 min) and postoperative data were collected from medical records. Levels of high-sensitivity cardiac troponin T (hs-cTnT) were measured on postoperative day 1. Myocardial damage was defined as an increase in the hs-cTnT value above 14 ng l. A cardiologist reviewed all cases of MI occurring within 30 days after surgery.
Main Outcome Measures:
Myocardial damage, MI and mortality within 30 days after surgery.
Results:
Of the final cohort of 300 patients, 90 (30%) had myocardial damage on postoperative day 1 and 15 (5%) developed postoperative MI within 30 days. Multivariate logistic regression analysis demonstrated that an intraoperative reduction in SBP more than 50% from baseline lasting more than 5 min was an independent predictor of postoperative hs-cTnT elevation (odds ratio, 4.4; 95% confidence interval, 1.8 to 11.1).
Conclusions:
In a cohort of 300 patients undergoing major elective noncardiac surgery, there was a high incidence of myocardial damage and an association between an intraoperative reduction in SBP more than 50% from baseline lasting more than 5 min and myocardial damage.
Insights
Major surgery can cause myocardial damage, with hypotension during surgery increasing risk. This study found a high incidence of myocardial damage and linked it to significant blood pressure drops, highlighting a critical perioperative concern.
Area of Science:
- Cardiology
- Anesthesiology
- Perioperative Medicine
Background:
- Perioperative myocardial damage and myocardial infarction (MI) are linked to increased mortality and postoperative complications.
- Identifying risk factors for perioperative myocardial damage is crucial for improving patient outcomes in noncardiac surgery.
Purpose of the Study:
- To determine the incidence of perioperative myocardial damage in patients undergoing major elective noncardiac surgery.
- To investigate the association between myocardial damage, postoperative MI, and mortality.
- To evaluate the impact of preoperative risk factors and intraoperative hypotension on myocardial damage.
Main Methods:
- An observational cohort study was conducted at a single center involving adult patients undergoing major elective noncardiac surgery.
- Data on preoperative comorbidities, intraoperative hypotension (defined as >50% SBP decrease for >5 min), and postoperative outcomes were collected.
- High-sensitivity cardiac troponin T (hs-cTnT) levels were measured on postoperative day 1; myocardial damage was defined as hs-cTnT > 14 ng/L.
Main Results:
- Of 300 patients, 90 (30%) experienced myocardial damage on postoperative day 1, and 15 (5%) developed postoperative MI within 30 days.
- Intraoperative hypotension (systolic blood pressure decrease >50% from baseline for >5 min) was an independent predictor of postoperative hs-cTnT elevation (OR, 4.4; 95% CI, 1.8–11.1).
Conclusions:
- A high incidence of myocardial damage was observed in patients undergoing major elective noncardiac surgery.
- A significant association exists between intraoperative hypotension and the occurrence of perioperative myocardial damage.
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