Study finds new benchmark for measuring risk of death from heart surgery
A large international study has found an important new benchmark for measuring the risk of death in patients undergoing heart surgery, of which there are two million adults a year worldwide.
Troponin levels (a type of protein found in heart muscle) have been used for years, through a blood test, to measure the risk of death and serious complications in patients with heart attack symptoms. However, this test is not commonly measured after heart surgery.
With limited data on patients undergoing coronary artery bypass grafting or open-heart surgery such as valve repairs and replacements, recommendations from medical experts varied widely (from 10 times to 70 times or more the normal laboratory value) regarding troponin levels that define heart attack and significant heart injury after heart surgery.
This study, published in the New England Journal of Medicine today assessed patients undergoing heart surgery, measured troponin before and daily for the first few days after surgery, and assessed mortality and the incidence of major vascular complications – such as heart attack, stroke or clot life-threatening blood – after heart surgery.
“We found that the troponin levels associated with an increased risk of death within 30 days were significantly higher – 200 to 500 times the normal value – than the troponin levels that surgical teams are currently told define the risk for a patient to have one of the common complications after heart surgery – myocardial injury, heart muscle injury associated with increased death,” said study lead researcher PJ Devereaux.
He is a Senior Scientist at the Population Health Research Institute at McMaster University and Hamilton Health Sciences (HHS), Professor of Medicine and Health Research Methodology at McMaster University, and Cardiologist at HHS.
The study found that 30 days after heart surgery, 2.1% of patients had died and 2.9% had suffered a major vascular complication, such as a heart attack, stroke or potentially transfer clot. deadly.
The study looked at 15,984 adult patients with an average age of just over 63 undergoing heart surgery. The patients came from 12 countries, with more than a third of the countries being outside of North America and Europe.
“This study is a landmark for healthcare teams caring for patients after cardiac surgery. For the first time, we have a rapid and reliable marker for monitoring these patients after cardiac surgery,” said André Lamy, investigator of the study. , PHRI scientist, professor in the Department of Surgery at McMaster, and cardiac surgeon at HHS.
“Our findings will help other studies examine the timing of treatments and procedures to improve patient outcomes after heart surgery,” said investigator Richard Whitlock, PHRI Associate Director and Research Scientist, Professor in the Department of McMaster surgery, cardiac and intensive care surgeon. doctor at HHS.
The VISION Cardiac Surgery Study was funded by the Canadian Institutes of Health Research, McMaster Surgical Associates, PHRI Internal Grant Award, HHS, Abbott, Ontario Strategy for Patient-Oriented Research, and Hamilton Academic Health Sciences Organization