Intraoperative Hypotension and Perioperative Myocardial Injury

Study Overview
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Brief Summary
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Acute myocardial infarction (MI) is a significant complication following non-cardiac surgery. We sought to evaluate incidence of perioperative MI, its preoperative - and intraoperative - risk factors and outcomes after this complication.

Detailed Description
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Background: In Sweden, over 800 000 patents undergo surgery each year. Worldwide, the number of surgical procedures yearly is over 310 million. Surgical care is en essential part of the advancement in treating disease, associated with increased lift expectancy a d improved quality of life. However as surgical volume continues to grow, the number of patients who suffer postoperative complications will also increase. Hemodynamic instability in the perioperative period is frequent and there has been a cumulative interest in this area and the relation to organ failure over the recent years. There are several studies showing results of associations between intraoperative hypotensive events and perioperative cardiac, kidney and cerebral injury, as well as increased mortality in high-risk surgical patients. More specifically the project aims to answer how intraoperative events, with a special focus on hypotension, are related to perioperative myocardial and kidney injury. We hypothesize that patients, with preoperative risk factors, undergoing major non-cardiac surgery are at increased risk of developing perioperative organ damage in the presence of intraoperative hypotension or other events such as tachycardia, hypoxia and extensive blood loss.

Official Title
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Association Between Intraoperative Hypotension and Perioperative Myocardial Injury: a Nested Case Control Study

Conditions
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Myocardial Infarction Postoperative, Myocardial Injury, Intraoperative Complications, Intraoperative Hypotension, Perioperative Complication

Participation Criteria
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Eligibility Criteria
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Cases Inclusion Criteria: Adults (≥18 years), male and female. Undergoing elective or non-elective in-patients non-cardiac surgery at 3 University Hospitals in Sweden: Karolinska University hospital, Skåne University hospital and Norrland University hospital. Surgeries performed between 2007 and 2014. Acute myocardial infarction criteria fulfilled within 30 days after surgery. Exclusion Criteria: Cardiac surgery Obstetric surgery Controls: Matched (on age, preoperative risk factors, surgical year- site and procedure) surgical patients without myocardial infarction within 30 days after surgery.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acute Myocardial Infarction | Acute MI, detected in the postoperative phase in the electronic medical records or in the Swedeheart Registry | Within 30 days after the index surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality | Death, detected in the postoperative phase in the Swedish Cause of Death Register. | Witis 30 days after the index surgery and at later predefined time points: 60, 90 180 and 365 days after the index surgery. |