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http://hdl.handle.net/11375/12503
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DC Field | Value | Language |
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dc.contributor.advisor | Devereaux, Philip | en_US |
dc.contributor.advisor | Guyatt, Gordon | en_US |
dc.contributor.advisor | Thabane, Lehana | en_US |
dc.contributor.author | Botto, Fernando | en_US |
dc.date.accessioned | 2014-06-18T16:59:50Z | - |
dc.date.available | 2014-06-18T16:59:50Z | - |
dc.date.created | 2012-09-19 | en_US |
dc.date.issued | 2012-10 | en_US |
dc.identifier.other | opendissertations/7385 | en_US |
dc.identifier.other | 8440 | en_US |
dc.identifier.other | 3334756 | en_US |
dc.identifier.uri | http://hdl.handle.net/11375/12503 | - |
dc.description.abstract | <p>Worldwide, more than 2 million patients die within 30 days after noncardiac surgery anually. Postoperative ischemic myocardial injury is frequent, however, no consensus exists about its definition.</p> <p><strong>Objective: </strong>to develop a term Myocardial Injury after Noncardiac Surgery (MINS) caused by myocardial ischemia, requiring at least, troponin T (TnT) elevation, and with prognostic relevance at 30 days after surgery.</p> <p><strong>Methods: </strong>we performed a prospective study including 15,167 patients ³45 years-old undergoing noncardiac surgery, who had fourth-generation TnT measurements during the first 3 postoperative days. We undertook Cox regression analyses with 30-day mortality after surgery as the dependent variable, using different TnT thresholds, clinical features and several perioperative variables. Non-ischemic etiologies were excluded. Furthermore, we developed a scoring system to predict risk in MINS patients.</p> <p><strong>Results:</strong> MINS was defined as TnT ≥0.03 ng/mL with or without clinical features, and it was an independent predictor of 30-day mortality (adjusted HR 3.82, CI 95% 2.84-5.10). We determined that MINS incidence was 8%, its population attributable risk 33.7%, and 30-days mortality rate 9.6%. Patients did not experience ischemic symptoms in 84% of MINS cases. Additionally, we developed a scoring system in patients suffering MINS with 3 independent predictors of death (age ≥75 years, new ST elevation or left bundle branch block, and anterior location of ECG changes),</p> <p><strong>Conclusion: </strong>Among patients undergoing noncardiac surgery, we defined MINS based on a TnT threshold ≥0.03 ng/mL. Mostly, MINS patients were asymptomatic. Therefore, this strongly suggests the importance of a troponin monitoring during the first few days after surgery.</p> | en_US |
dc.subject | Myocardial injury | en_US |
dc.subject | Myocardial ischemia | en_US |
dc.subject | Noncardiac surgery | en_US |
dc.subject | Troponin | en_US |
dc.subject | Perioperative | en_US |
dc.subject | Medicine and Health Sciences | en_US |
dc.subject | Medicine and Health Sciences | en_US |
dc.title | Myocardial Injury after Noncardiac Surgery (MINS) | en_US |
dc.type | thesis | en_US |
dc.contributor.department | Health Research Methodology | en_US |
dc.description.degree | Master of Health Sciences (MSc) | en_US |
Appears in Collections: | Open Access Dissertations and Theses |
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fulltext.pdf | 1.35 MB | Adobe PDF | View/Open |
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