Introduction:Perioperative myocardial injury(PMI)is associated with increased mortality.We describe risk factors for and outcomes of PMI in patients undergoing tracheotomy.Methods:Retrospective study of patients under...Introduction:Perioperative myocardial injury(PMI)is associated with increased mortality.We describe risk factors for and outcomes of PMI in patients undergoing tracheotomy.Methods:Retrospective study of patients undergoing tracheotomy from 2007 to 2016.PMI was defined by a postoperative cardiac troponin I(cTnI)>99th percentile.Demographics and comorbidities were extracted from the electronic medical record and compared between patients with and without PMI.Significant univariate predictors were included in a multivariable logistic regression model to determine independent predictors of PMI.Thirty-day and 1-year mortality of patients with and without PMI were compared.Results:Of 861 patients undergoing tracheotomy,41(4.76%)had PMI and 820(95.24%)did not.PMI was associated with higher mortality at both 30 days(40.5%vs.11.2%,p<0.001)and 1 year(73.2%vs.44.1%,p<0.001).Patients with PMI were older(median age 65 vs.60,p=0.002)and more likely to have prior myocardial infarction(MI)(36.6%vs.10.7%,p<0.001)and chronic kidney disease(31.7%vs.16.7%,p=0.024).Cancer diagnosis was associated with a lower risk of PMI(24.4%vs.41.8%,p=0.041).Older age(odds ratio[OR]=1.033,p<0.001)and prior MI(OR=3.686,p<0.001)were independently associated with PMI.Conclusion:Patients with PMI following tracheotomy had increased short-and long-term mortality.Increased age and history of prior MI were independent predictors of PMI,while cancer was associated with a lower risk of PMI following tracheotomy.ICU patients likely have more acute ailments contributing to a higher risk of PMI and poorer outcomes compared to cancer patients requiring tracheotomy.We propose routine screening for PMI with cTnI in the postoperative period in all tracheotomy patients.展开更多
文摘Introduction:Perioperative myocardial injury(PMI)is associated with increased mortality.We describe risk factors for and outcomes of PMI in patients undergoing tracheotomy.Methods:Retrospective study of patients undergoing tracheotomy from 2007 to 2016.PMI was defined by a postoperative cardiac troponin I(cTnI)>99th percentile.Demographics and comorbidities were extracted from the electronic medical record and compared between patients with and without PMI.Significant univariate predictors were included in a multivariable logistic regression model to determine independent predictors of PMI.Thirty-day and 1-year mortality of patients with and without PMI were compared.Results:Of 861 patients undergoing tracheotomy,41(4.76%)had PMI and 820(95.24%)did not.PMI was associated with higher mortality at both 30 days(40.5%vs.11.2%,p<0.001)and 1 year(73.2%vs.44.1%,p<0.001).Patients with PMI were older(median age 65 vs.60,p=0.002)and more likely to have prior myocardial infarction(MI)(36.6%vs.10.7%,p<0.001)and chronic kidney disease(31.7%vs.16.7%,p=0.024).Cancer diagnosis was associated with a lower risk of PMI(24.4%vs.41.8%,p=0.041).Older age(odds ratio[OR]=1.033,p<0.001)and prior MI(OR=3.686,p<0.001)were independently associated with PMI.Conclusion:Patients with PMI following tracheotomy had increased short-and long-term mortality.Increased age and history of prior MI were independent predictors of PMI,while cancer was associated with a lower risk of PMI following tracheotomy.ICU patients likely have more acute ailments contributing to a higher risk of PMI and poorer outcomes compared to cancer patients requiring tracheotomy.We propose routine screening for PMI with cTnI in the postoperative period in all tracheotomy patients.
