Perioperative myocardial injury in patients receiving cardiac output-guided haemodynamic therapy: a substudy of the OPTIMISE Trial

M. A. Gillies*, A. S. V. Shah, J. Mullenheim, S. Tricklebank, T. Owen, J. Antonelli, Fiona Strachan, N. L. Mills, R. M. Pearse

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Evidence suggests that cardiac output-guided haemodynamic therapy algorithms improve outcomes after high-risk surgery, but there is some concern that this could promote acute myocardial injury. We evaluated the incidence of myocardial injury in a perioperative goal-directed therapy trial.

Methods: Patients undergoing major gastrointestinal surgery (n=723) were randomly assigned to cardiac output-guided haemodynamic therapy (intervention group) or usual care as part of the OPTIMISE trial. At four participating sites, 288 patients were enrolled in a biomarker substudy. Serum high-sensitivity cardiac troponin I (TnI) concentration and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration were measured before and at 24 and 72 h after surgery.

Results: Median preoperative TnI and NT-ProBNP concentrations were 4.3 ng litre(-1) and 144 pg ml(-1), respectively. After surgery, 67 (46%) patients in the intervention group and 68 (48%) patients receiving usual care had Till concentrations above the 99th centile upper reference limit (P=0.82). Peak serum TnI concentration was similar in the intervention and usual care groups (median [interquartile range]: 10.0 [5.3-21.5] vs 7.8 [5.0-21.8] ng litre(-1); P=0.85), and no differences were observed in serum TnI concentrations over 72 h (repeated-measures ANOVA, P=0.51). Likewise, there were no differences in peak NT-proBNP concentration between intervention and usual care groups (645 [362-1169] us 659 [381-1028] pg ml(-1); P=0.86) or in serial NT-proBNP concentrations over 72 h (P=0.20).

Conclusions: Myocardial injury is common among patients undergoing major gastrointestinal surgery. In this study, the frequency was not affected by cardiac output-guided fluid and low-dose inotropic therapy.

Original languageEnglish
Pages (from-to)227-233
Number of pages7
JournalBritish Journal of Anaesthesia
Volume115
Issue number2
DOIs
Publication statusPublished - 21 May 2015

Keywords / Materials (for Non-textual outputs)

  • biochemistry
  • complications, myocardial infarction
  • fluids, i.v
  • heart, dopexamine
  • surgery
  • CORONARY-ARTERY-DISEASE
  • BRAIN NATRIURETIC PEPTIDE
  • EARLY SEPTIC SHOCK
  • TROPONIN-I ASSAY
  • NONCARDIAC SURGERY
  • RANDOMIZED-TRIAL
  • PROGNOSTIC VALUE
  • MAJOR SURGERY
  • PROSPECTIVE COHORT
  • VASCULAR-SURGERY

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