The incidence of myocardial injury following post-operative Goal Directed Therapy.
BACKGROUND
Studies suggest that Goal Directed Therapy (GDT) results in improved outcome following major surgery. However, there is concern that pre-emptive use of inotropic therapy may lead to an increased incidence of myocardial ischaemia and infarction.


METHODS
Post hoc analysis of data collected prospectively during a randomised controlled trial of the effects of post-operative GDT in high-risk general surgical patients. Serum troponin T concentrations were measured at baseline and on day 1 and day 2 following surgery. Continuous ECG monitoring was performed during the eight hour intervention period. Patients were followed up for predefined cardiac complications. A univariate analysis was performed to identify any associations between potential risk factors for myocardial injury and elevated troponin T concentrations.


RESULTS
GDT was associated with fewer complications, and a reduced duration of hospital stay. Troponin T concentrations above 0.01 microg l-1 were identified in eight patients in the GDT group and six in the control group. Values increased above 0.05 microg l-1 in four patients in the GDT group and two patients in the control group. There were no overall differences in the incidence of elevated troponin T concentrations. The incidence of cardiovascular complications was also similar. None of the patients, in whom troponin T concentrations were elevated, developed ECG changes indicating myocardial ischaemia during the intervention period. The only factor to be associated with elevated troponin T concentrations following surgery was end-stage renal failure.


CONCLUSIONS
The use of post-operative GDT does not result in an increased incidence of myocardial injury.
Pearse
Rupert M
RM
Barts and The London School of Medicine and Dentistry, Queen Mary's University of London, UK. rupert.pearse@bartsandthelondon.nhs.uk
Dawson
Deborah
D
Fawcett
Jayne
J
Rhodes
Andrew
A
Grounds
R Michael
RM
Bennett
David
D
D002316:Cardiotonic Agents / Q000009:adverse effects*; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011182:Postoperative Care / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*
D002316:Cardiotonic Agents; D020107:Troponin T