title: Intraoperative hypotension is associated with myocardial damage in noncardiac surgery: An observational study.
abstract: BACKGROUND
  Perioperative myocardial damage and infarction (MI) is associated with increased mortality and other postoperative complications.
  
  
  OBJECTIVE
  To assess the incidence of perioperative myocardial damage in patients undergoing major elective noncardiac surgery, to elucidate any association with postoperative MI and mortality and to estimate the impact of preoperative risk factors and intraoperative hypotension.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Karolinska University Hospital, Stockholm, Sweden, from October 2012 to May 2013.
  
  
  METHODS
  In this single-centre study, all adult patients undergoing major elective noncardiac surgery who were scheduled for an overnight admission to the postoperative unit were included. Patients undergoing phaeochromocytoma surgery were excluded. Preoperative risk factors (co-morbidities), intraoperative events (hypotension defined as a 50% decrease in SBP relative to each patient's baseline and lasting >5 min) and postoperative data were collected from medical records. Levels of high-sensitivity cardiac troponin T (hs-cTnT) were measured on postoperative day 1. Myocardial damage was defined as an increase in the hs-cTnT value above 14 ng l. A cardiologist reviewed all cases of MI occurring within 30 days after surgery.
  
  
  METHODS
  Myocardial damage, MI and mortality within 30 days after surgery.
  
  
  RESULTS
  Of the final cohort of 300 patients, 90 (30%) had myocardial damage on postoperative day 1 and 15 (5%) developed postoperative MI within 30 days. Multivariate logistic regression analysis demonstrated that an intraoperative reduction in SBP more than 50% from baseline lasting more than 5 min was an independent predictor of postoperative hs-cTnT elevation (odds ratio, 4.4; 95% confidence interval, 1.8 to 11.1).
  
  
  CONCLUSIONS
  In a cohort of 300 patients undergoing major elective noncardiac surgery, there was a high incidence of myocardial damage and an association between an intraoperative reduction in SBP more than 50% from baseline lasting more than 5 min and myocardial damage.
authors.affiliation: From the Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital, Solna (LH); Department of Intensive Care, Austin Hospital, Melbourne, Australia, and Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital, Solna (JM); Clinical Epidemiology Unit at Karolinska University Hospital (FG); National Heart Singapore, and Department of Cardiovascular Medicine, Karolinska University Hospital, Huddinge (AS); and Department of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital, Solna (MB).
authors.forename: Linn
authors.initials: L
authors.lastname: Hallqvist
authors.forename: Johan
authors.initials: J
authors.lastname: Mårtensson
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granath
authors.forename: Anders
authors.initials: A
authors.lastname: Sahlén
authors.forename: Max
authors.initials: M
authors.lastname: Bell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D009202:Cardiomyopathies / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000453:epidemiology*; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T