Please use this identifier to cite or link to this item:
https://hdl.handle.net/11055/201
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DC Field | Value | Language |
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dc.contributor.author | McIlroy, DR | - |
dc.contributor.author | Chan, MTV | - |
dc.contributor.author | Wallace, S K | - |
dc.contributor.author | Symons, JA | - |
dc.contributor.author | Loo, E G Y | - |
dc.contributor.author | Chu, LCY | - |
dc.contributor.author | Myles, PS | - |
dc.date | 2013 | - |
dc.date.accessioned | 2018-03-08T00:48:28Z | - |
dc.date.available | 2018-03-08T00:48:28Z | - |
dc.date.issued | 2014-01 | - |
dc.identifier.citation | British journal of anaesthesia 2014-01; 112(1): 47-56 | - |
dc.identifier.uri | http://hdl.handle.net/11055/201 | - |
dc.description.abstract | Myocardial 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. We 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 μg litre(-1), within 3 postoperative days. The 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. For 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. | - |
dc.language.iso | eng | - |
dc.subject.mesh | Automation | - |
dc.subject.mesh | Cardiomyopathies | - |
dc.subject.mesh | Endothelium, Vascular | - |
dc.subject.mesh | Perioperative Period | - |
dc.subject.mesh | Postoperative Complications | - |
dc.subject.mesh | Prospective Studies | - |
dc.subject.mesh | ROC Curve | - |
dc.subject.mesh | Risk | - |
dc.subject.mesh | Intraoperative Care | - |
dc.title | Automated preoperative assessment of endothelial dysfunction and risk stratification for perioperative myocardial injury in patients undergoing non-cardiac surgery. | - |
dc.type | Journal Article | - |
dc.type | Research Support, Non-U.S. Gov't | - |
dc.identifier.journaltitle | British journal of anaesthesia | - |
dc.identifier.doi | 10.1093/bja/aet354 | - |
dc.description.pubmeduri | https://www.ncbi.nlm.nih.gov/pubmed/24172055 | - |
dc.identifier.pubmedid | 24172055 | - |
dc.ispartof.anzcaresearchfoundation | Yes | - |
item.openairecristype | http://purl.org/coar/resource_type/c_18cf | - |
item.openairecristype | http://purl.org/coar/resource_type/c_18cf | - |
item.fulltext | No Fulltext | - |
item.cerifentitytype | Publications | - |
item.cerifentitytype | Publications | - |
item.openairetype | Journal Article | - |
item.openairetype | Research Support, Non-U.S. Gov't | - |
item.grantfulltext | none | - |
item.languageiso639-1 | en | - |
Appears in Collections: | Scholarly and Clinical |
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