Automated preoperative assessment of endothelial dysfunction and risk stratification for perioperative myocardial injury in patients undergoing non-cardiac surgery

David R McIlroy, Matthew T V Chan, Sophie K Wallace, Joel Symons, E G Y Koo, L C Y Chu, Paul S Myles

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20 Citations (Scopus)

Abstract

BackgroundMyocardial injury after non-cardiac surgery (MINS) is a common complication with associated serious morbidity and mortality. Endothelial dysfunction might play an important role in MINS, and its rapid assessment could provide a novel method of risk stratification before surgery.MethodsWe studied 238 subjects scheduled to undergo intermediate or high-risk surgery in a two-centre prospective study to determine whether preoperative endothelial dysfunction identified by a reactive hyperaemia-peripheral arterial tonometry (RH-PAT) index could provide effective risk stratification for MINS, defined as serum troponin =0.04 ?g litre-1, within 3 postoperative days.ResultsThe primary outcome occurred in 35 subjects (14.7 ). Endothelial dysfunction was defined as an RH-PAT index of =1.22. Adjusted for age, Lee index and a composite measure of the extent of surgery, endothelial dysfunction was associated with MINS [odds ratio 10.1, 95 confidence interval (CI) 3.3-30.9, P=0.001] and increased time to discharge from hospital after surgery (hazard ratio 0.39, 95 CI 0.23-0.65, P=0.001). Endothelial dysfunction identified MINS with a sensitivity of 31 , a specificity of 96 , and a positive diagnostic likelihood ratio of 8.0. Risk classification for MINS was improved by the addition of RH-PAT-defined endothelial dysfunction to the Lee index (c-statistic increased from 0.69 to 0.77; integrated discrimination improvement 0.11, P=0.003). However, prognostic utility varied widely between sites.ConclusionsFor patients undergoing non-cardiac surgery, non-invasive assessment of endothelial function might enhance preoperative risk stratification for perioperative myocardial injury. However, unexplained large inter-site variation in prognostic utility could limit widespread application and needs to be further understood. ? 2014 The Author .
Original languageEnglish
Pages (from-to)47 - 56
Number of pages10
JournalBritish Journal of Anaesthesia
Volume112
Issue number1
DOIs
Publication statusPublished - 2014

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