871aaa97746e41d8dc8fea33a3e35b84 301118.pdf 21d6c1540ef9e1e68636d270284aaf61f3b57309 301118.pdf 54a2d3e872d68a109cd824465df0ff0f42afccb9dadf1b880c1efaa1b95c34f9 301118.pdf Title: The Relevance of Implementing the Systematic Screening of Perioperative Myocardial Injury in Noncardiac Surgery Patients Subject: Perioperative myocardial injury (PMI) is a common cardiac complication. Recent guidelines recommend its systematic screening using high-sensitivity cardiac troponin (hs-cTn). However, there is limited evidence of local screening programs. We conducted a prospective, single-center study aimed at assessing the feasibility and outcomes of implementing systematic PMI screening. Hs-cTn concentrations were measured before and after surgery. PMI was defined as a postoperative hs-cTnT of 14 ng/L, exceeding the preoperative value by 50%. All patients were followed-up during the hospitalization, at one month and one year after surgery. The primary outcome was the incidence of death and major cardiovascular and cerebrovascular events (MACCE). The secondary outcomes focused on the individual components of MACCE. We included two-thirds of all eligible high-risk patients and achieved almost complete compliance with follow-ups. The prevalence of PMI was 15.7%, suggesting a higher presence of cardiovascular (CV) antecedents, increased perioperative CV complications, and higher preoperative hs-cTnT values. The all-cause death rate was 1.7% in the first month, increasing up to 11.2% at one year. The incidence of MACCE was 9.5% and 8.6% at the same time points. Given the observed elevated frequencies of PMI and MACCE, implementing systematic PMI screening is recommendable, particularly in patients with increased cardiovascular risk. However, it is important to acknowledge that achieving optimal screening implementation comes with various challenges and complexities.24pt Keywords: perioperative myocardial injury; screening; high sensitivity cardiac troponin T; noncardiac surgery Author: Ekaterine Popova, Pilar Paniagua-Iglesias, Jesús Álvarez-García, Miquel Vives-Borrás, Aránzazu González-Osuna, Álvaro García-Osuna, Mercedes Rivas-Lasarte, Gisela Hermenegildo-Chavez, Ruben Diaz-Jover, Gonzalo Azparren-Cabezon, Montserrat Barceló-Trias, Abdel-Hakim Moustafa, Raul Aguilar-Lopez, Jordi Ordonez-Llanos and Pablo Alonso-Coello Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Fri Aug 18 10:29:06 2023 CEST ModDate: Fri Aug 18 10:35:17 2023 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1272867 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- TAGTVB+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 IYDCBB+VnURWPalladioL Type 1 Custom yes yes no 15 0 QDCOHQ+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 ETVPMN+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 INMCVG+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 WIYEYL+CMSY10 Type 1 Builtin yes yes no 32 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 50 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 53 0 GMICCO+PalatinoLinotype CID TrueType Identity-H yes yes yes 91 0 GMICDB+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 97 0 GMICCN+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 100 0 GMICCP+PalatinoLinotype TrueType WinAnsi yes yes no 103 0 GMIDGL+PalatinoLinotype TrueType MacRoman yes yes no 106 0 GMICCO+PalatinoLinotype CID TrueType Identity-H yes yes yes 120 0 GMICDB+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 126 0 GMICCN+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 129 0 GMICCP+PalatinoLinotype TrueType WinAnsi yes yes no 132 0 GMIFJA+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 135 0 GMIDGL+PalatinoLinotype TrueType MacRoman yes yes no 138 0 FAECIJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 145 0 GMICCO+PalatinoLinotype CID TrueType Identity-H yes yes yes 162 0 GMICDB+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 168 0 GMICCN+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 171 0 GMICCP+PalatinoLinotype TrueType WinAnsi yes yes no 174 0 GMIFJA+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 177 0 GMIDGL+PalatinoLinotype TrueType MacRoman yes yes no 180 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-09-24 02:56:59 CEST RepresentationInformation: 301118.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-09-23 12:24:05 CEST Size: 1272867 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 377 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Characteristics Destination: subsection.2.1 Children: Item: Title: Study Site and Design Destination: subsubsection.2.1.1 Item: Title: Time of the Study Destination: subsubsection.2.1.2 Item: Title: Ethics and Patient Recruitment Destination: subsubsection.2.1.3 Item: Title: The Research Team and hs-cTnT Screening Implementation Management Destination: subsubsection.2.1.4 Item: Title: Data Collection and Management Destination: subsubsection.2.1.5 Item: Title: Study Population Destination: subsection.2.2 Children: Item: Title: Cardiac Biomarker Measurements Destination: subsubsection.2.2.1 Item: Title: PMI Definition, Diagnostic, and Management Destination: subsubsection.2.2.2 Item: Title: Follow-Up Destination: subsubsection.2.2.3 Item: Title: Outcomes Destination: subsection.2.3 Item: Title: Statistical Analysis Destination: subsection.2.4 Item: Title: Results Destination: section.3 Children: Item: Title: Hs-cTnT Screening Implementation Management Destination: subsection.3.1 Children: Item: Title: Cardiac Biomarker Availability at Recruitment Destination: subsubsection.3.1.1 Item: Title: PMI Incidence, Clinical Data of Patients Destination: subsubsection.3.1.2 Item: Title: Immediate Postoperative Assessment Destination: subsubsection.3.1.3 Item: Title: Follow-Up and Outcomes Destination: subsection.3.2 Item: Title: Cardiovascular Drugs Use Pre and Postintervention Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Children: Item: Title: Screening Implementation. Barriers and Facilitators Destination: subsection.4.1 Item: Title: PMI Diagnosis, Incidence, and Characteristics Destination: subsection.4.2 Item: Title: Outcomes in the Follow-Ups Destination: subsection.4.3 Item: Title: Implications for Clinical Practice Destination: subsection.4.4 Item: Title: Limitations and Strengths Destination: subsection.4.5 Item: Title: Conclusions Destination: section.5 Item: Title: Patients Destination: section.6 Item: Title: References Destination: section.A. Info: Title: The Relevance of Implementing the Systematic Screening of Perioperative Myocardial Injury in Noncardiac Surgery Patients Author: Ekaterine Popova, Pilar Paniagua-Iglesias, Jesús Álvarez-García, Miquel Vives-Borrás, Aránzazu González-Osuna, Álvaro García-Osuna, Mercedes Rivas-Lasarte, Gisela Hermenegildo-Chavez, Ruben Diaz-Jover, Gonzalo Azparren-Cabezon, Montserrat Barceló-Trias, Abdel-Hakim Moustafa, Raul Aguilar-Lopez, Jordi Ordonez-Llanos and Pablo Alonso-Coello Subject: Perioperative myocardial injury (PMI) is a common cardiac complication. Recent guidelines recommend its systematic screening using high-sensitivity cardiac troponin (hs-cTn). However, there is limited evidence of local screening programs. We conducted a prospective, single-center study aimed at assessing the feasibility and outcomes of implementing systematic PMI screening. Hs-cTn concentrations were measured before and after surgery. PMI was defined as a postoperative hs-cTnT of 14 ng/L, exceeding the preoperative value by 50%. All patients were followed-up during the hospitalization, at one month and one year after surgery. The primary outcome was the incidence of death and major cardiovascular and cerebrovascular events (MACCE). The secondary outcomes focused on the individual components of MACCE. We included two-thirds of all eligible high-risk patients and achieved almost complete compliance with follow-ups. The prevalence of PMI was 15.7%, suggesting a higher presence of cardiovascular (CV) antecedents, increased perioperative CV complications, and higher preoperative hs-cTnT values. The all-cause death rate was 1.7% in the first month, increasing up to 11.2% at one year. The incidence of MACCE was 9.5% and 8.6% at the same time points. Given the observed elevated frequencies of PMI and MACCE, implementing systematic PMI screening is recommendable, particularly in patients with increased cardiovascular risk. 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