Development and Internal Validation of Models Involving Vital Signs to Predict Troponin Level and Myocardial Injury After Non-cardiac Surgery: a Single-centre Retrospective Cohort Study
试验速览
- 阶段
- 不适用
- 入组人数
- 750
- 试验地点
- 1
- 主要终点
- High Sensitivity Troponin (hsTnT) levels (daily)
研究概览
简要总结
The incidence of myocardial injury after non-cardiac surgery (MINS) is approximately 12-15% and is associated with an increased risk of 30-day mortality, 1-year mortality, and 2-year major vascular events. Using both traditional longitudinal analysis techniques and novel methods in machine learning, investigators will explore whether intraoperative and postoperative vital signs can enhance MINS surveillance by providing temporal prediction of MINS events.
详细描述
The incidence of myocardial injury after non-cardiac surgery (MINS) is approximately 12-15% and is associated with an increased risk of 30-day mortality, 1-year mortality, and 2-year major vascular events. Since more than 90% of patients with MINS are asymptomatic, routine troponin monitoring is required for detection. The postoperative days 0, 1, and 2 accounts for approximately 40%, 40%, and 10% of MINS, respectively. Presently, the Canadian Cardiovascular Society (CCS) perioperative guidelines recommend patients identified to be at risk according to the Revised Cardiac Risk Index (RCRI) and BNP/NT-pro B-type Natriuretic Peptide (NT-pro BNP) receive daily postoperative troponin monitoring for three days to identify MINS events (5). European and American societies have similar recommendations for troponin monitoring to detect MINS.
Current risk stratification models have multiple limitations. Most importantly, they predict an elevated risk over the postoperative period but cannot pinpoint when MINS may happen in the postoperative course given the patients' changing condition. Moreover, prescription of troponin monitoring is not universal, infrequent and inconsistent troponin monitoring may lead to delayed detection and management, and the rise of troponin is delayed by 3-4 hours from the time of injury.
Retrospective cohort studies show association amongst intraoperative and postoperative derangements in vital signs and MINS. Vital signs are routinely available within the electronic medical record, and may serve as objective predictors (i.e. as opposed to free text and disease names that have higher risks of misclassification and errors).
Using both traditional longitudinal analysis techniques and novel methods in machine learning, investigators will explore whether intraoperative and postoperative vital signs can enhance MINS surveillance by providing temporal prediction of MINS events.
Objectives
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 45 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Patients who underwent inpatient noncardiac surgery, who had myocardial injury after non-cardiac surgery (MINS) protocol ordered for postoperative high sensitivity troponin monitoring based on the Canadian Cardiovascular Society (CCS) guidelines
- •Patients who underwent inpatient non-cardiac surgery from January 2020 to June 2021.
排除标准
- •Patients who did not have intraoperative and postoperative vital signs
- •Patients who did not have any postoperative troponin measurements
- •Patients who underwent repeat surgery
- •Patients who were readmitted within the first 72 hours postoperatively
- •Patients who had positive troponin on postoperative day 4
结局指标
主要结局
High Sensitivity Troponin (hsTnT) levels (daily)
时间窗: Up to and including postoperative day 2
High-sensitivity troponin (hsTnT) level as a continuous outcome (up to and including postoperative day 2)
次要结局
- Myocardial injury after non-cardiac surgery (MINS) (daily)(Up to and including postoperative day 3)
- High Sensitivity Troponin (hsTnT) levels (daily)(Up to and including postoperative day 3)
研究者
Su-Yin MacDonell
Clinical Assistant Professor
University of British Columbia