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Lavikainen LI, Guyatt GH, Sallinen VJ, Karanicolas PJ, Couban RJ, Singh T, Lee Y, Elberkennou J, Aaltonen R, Ahopelto K, Beilmann-Lehtonen I, Blanker MH, Cárdenas JL, Cartwright R, Craigie S, Devereaux P, Garcia-Perdomo HA, Ge FZ, Gomaa HA, Halme AL, Haukka J, Karjalainen PK, Kilpeläinen TP, Kivelä AJ, Lampela H, Mattila AK, Najafabadi BT, Nykänen TP, Pandanaboyana S, Pourjamal N, Ratnayake CB, Raudasoja A, Vernooij RW, Violette PD, Wang Y, Xiao Y, Yao L, Tikkinen KAO. Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper Gastrointestinal, and Hepatopancreatobiliary Surgery. Ann Surg 2024; 279:213-225. [PMID: 37551583 PMCID: PMC10782937 DOI: 10.1097/sla.0000000000006059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery. BACKGROUND The use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain. METHODS We identified observational studies reporting procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery, adjusted the reported estimates for thromboprophylaxis and length of follow-up, and estimated cumulative incidence at 4 weeks postsurgery, stratified by VTE risk groups, and rated evidence certainty. RESULTS After eligibility screening, 285 studies (8,048,635 patients) reporting on 40 general abdominal, 36 colorectal, 15 upper gastrointestinal, and 24 hepatopancreatobiliary surgery procedures proved eligible. Evidence certainty proved generally moderate or low for VTE and low or very low for bleeding requiring reintervention. The risk of VTE varied substantially among procedures: in general abdominal surgery from a median of <0.1% in laparoscopic cholecystectomy to a median of 3.7% in open small bowel resection, in colorectal from 0.3% in minimally invasive sigmoid colectomy to 10.0% in emergency open total proctocolectomy, and in upper gastrointestinal/hepatopancreatobiliary from 0.2% in laparoscopic sleeve gastrectomy to 6.8% in open distal pancreatectomy for cancer. CONCLUSIONS VTE thromboprophylaxis provides net benefit through VTE reduction with a small increase in bleeding in some procedures (eg, open colectomy and open pancreaticoduodenectomy), whereas the opposite is true in others (eg, laparoscopic cholecystectomy and elective groin hernia repairs). In many procedures, thromboembolism and bleeding risks are similar, and decisions depend on individual risk prediction and values and preferences regarding VTE and bleeding.
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Affiliation(s)
| | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ville J. Sallinen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paul J. Karanicolas
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rachel J. Couban
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Tino Singh
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Yung Lee
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Riikka Aaltonen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaisa Ahopelto
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ines Beilmann-Lehtonen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marco H. Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jovita L. Cárdenas
- Direction of Health Technologies Assessment, National Center for Health Technology Excellence (CENETEC), Mexico City, Mexico
| | - Rufus Cartwright
- Departments of Gynecology and Gender Affirmation Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Samantha Craigie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - P.J. Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Anesthesiology, Perioperative Medicine, and Surgical Research Group, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Department of Outcomes Research, Outcomes Research Consortium, Cleveland, OH, USA
| | - Herney A. Garcia-Perdomo
- Department of Surgery, Division of Urology, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Fang Zhou Ge
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Huda A. Gomaa
- Department of Biostatistics, High Institute of Public Health, Alexandria University, Egypt
- Department of Medical Pharmacology, Tanta Chest Hospital, Ministry of Health and Population, Tanta, Egypt
| | - Alex L.E. Halme
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Haukka
- Health Sciences, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Clinicum/Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Päivi K. Karjalainen
- Department of Obstetrics and Gynecology, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Tuomas P. Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti J. Kivelä
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Lampela
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne K. Mattila
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Borna Tadayon Najafabadi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Sanjay Pandanaboyana
- Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Negar Pourjamal
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Chathura B.B. Ratnayake
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | | | - Robin W.M. Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philippe D. Violette
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Yuting Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Yingqi Xiao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Nursing and West China School of Nursing, West China Hospital and Sichuan University, Chengdu, China
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Kari A. O. Tikkinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland
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2
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Lamy A, Chertow GM, Jessen M, Collar A, Brown CD, Mack CA, Marzouk M, Scavo V, Washburn TB, Savage D, Smith J, Bennetts J, Assi R, Shults C, Arghami A, Butler J, Devereaux P, Zager R, Wang C, Snapinn S, Browne A, Rodriguez J, Ruiz S, Singh B. Effects of RBT-1 on preconditioning response biomarkers in patients undergoing coronary artery bypass graft or heart valve surgery: a multicentre, double-blind, randomised, placebo-controlled phase 2 trial. EClinicalMedicine 2024; 68:102364. [PMID: 38586479 PMCID: PMC10994969 DOI: 10.1016/j.eclinm.2023.102364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 04/09/2024] Open
Abstract
Background RBT-1 is a combination drug of stannic protoporfin (SnPP) and iron sucrose (FeS) that elicits a preconditioning response through activation of antioxidant, anti-inflammatory, and iron-scavenging pathways, as measured by heme oxygenase-1 (HO-1), interleukin-10 (IL-10), and ferritin, respectively. Our primary aim was to determine whether RBT-1 administered before surgery would safely and effectively elicit a preconditioning response in patients undergoing cardiac surgery. Methods This phase 2, double-blind, randomised, placebo-controlled, parallel-group, adaptive trial, conducted in 19 centres across the USA, Canada, and Australia, enrolled patients scheduled to undergo non-emergent coronary artery bypass graft (CABG) and/or heart valve surgery with cardiopulmonary bypass. Patients were randomised (1:1:1) to receive either a single intravenous infusion of high-dose RBT-1 (90 mg SnPP/240 mg FeS), low-dose RBT-1 (45 mg SnPP/240 mg FeS), or placebo within 24-48 h before surgery. The primary outcome was a preoperative preconditioning response, measured by a composite of plasma HO-1, IL-10, and ferritin. Safety was assessed by adverse events and laboratory parameters. Prespecified adaptive criteria permitted early stopping and enrichment. This trial is registered with ClinicalTrials.gov, NCT04564833. Findings Between Aug 4, 2021, and Nov 9, 2022, of 135 patients who were enrolled and randomly allocated to a study group (46 high-dose, 45 low-dose, 44 placebo), 132 (98%) were included in the primary analysis (46 high-dose, 42 low-dose, 44 placebo). At interim, the trial proceeded to full enrollment without enrichment. RBT-1 led to a greater preconditioning response than did placebo at high-dose (geometric least squares mean [GLSM] ratio, 3.58; 95% CI, 2.91-4.41; p < 0.0001) and low-dose (GLSM ratio, 2.62; 95% CI, 2.11-3.24; p < 0.0001). RBT-1 was generally well tolerated by patients. The primary drug-related adverse event was dose-dependent photosensitivity, observed in 12 (26%) of 46 patients treated with high-dose RBT-1 and in six (13%) of 45 patients treated with low-dose RBT-1 (safety population). Interpretation RBT-1 demonstrated a statistically significant cytoprotective preconditioning response and a manageable safety profile. Further research is needed. A phase 3 trial is planned. Funding Renibus Therapeutics, Inc.
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Affiliation(s)
- Andre Lamy
- Department of Perioperative Medicine and Surgery, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Glenn M. Chertow
- Departments of Medicine and Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alonso Collar
- Department of Thoracic Surgery and Vascular Surgery, MyMichigan Health, Midland, MI, USA
| | - Craig D. Brown
- Department of Cardiac Surgery, New Brunswick Heart Centre, Saint John, New Brunswick, Canada
| | - Charles A. Mack
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mohamed Marzouk
- Department of Cardiac Surgery, Québec Heart and Lung Institute, Québec, Québec, Canada
| | - Vincent Scavo
- Department of Cardiovascular and Thoracic Surgery, Lutheran Medical Group, Fort Wayne, Indiana, USA
| | - T Benton Washburn
- Department of Cardiothoracic Surgery, Huntsville Hospital Heart Center, Huntsville, AL, USA
| | - David Savage
- Department of Cardiothoracic Surgery, Indiana University Health, Bloomington, IN, USA
| | - Julian Smith
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University and Department of Cardiothoracic Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Jayme Bennetts
- Department of Cardiothoracic Surgery, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
- Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Roland Assi
- Department of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Christian Shults
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - P.J. Devereaux
- Department of Perioperative Medicine and Surgery, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Richard Zager
- Department of Drug Development & Medical Affairs, Renibus Therapeutics Inc, Southlake, TX, USA
| | - Chao Wang
- Pharma Data Associates LLC, Piscataway, NJ, USA
| | - Steve Snapinn
- Seattle-Quilcene Biostatistics LLC, Seattle, WA, USA
| | - Austin Browne
- Department of Perioperative Medicine and Surgery, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jeannette Rodriguez
- Department of Drug Development & Medical Affairs, Renibus Therapeutics Inc, Southlake, TX, USA
| | - Stacey Ruiz
- Department of Drug Development & Medical Affairs, Renibus Therapeutics Inc, Southlake, TX, USA
| | - Bhupinder Singh
- Department of Drug Development & Medical Affairs, Renibus Therapeutics Inc, Southlake, TX, USA
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3
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Connolly SJ, Healey JS, Belley-Cote EP, Balasubramanian K, Paparella D, Brady K, Reents W, Danner BC, Devereaux P, Sharma M, Ramasundarahettige C, Yusuf S, Whitlock RP. Oral Anticoagulation Use and Left Atrial Appendage Occlusion in LAAOS III. Circulation 2023; 148:1298-1304. [PMID: 37732457 PMCID: PMC10589428 DOI: 10.1161/circulationaha.122.060315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/17/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND LAAOS III (Left Atrial Appendage Occlusion Study III) showed that left atrial appendage (LAA) occlusion reduces the risk of ischemic stroke or systemic embolism in patients with atrial fibrillation undergoing cardiac surgery. This article examines the effect of LAA occlusion on stroke reduction according to variation in the use of oral anticoagulant (OAC) therapy. METHODS Information regarding OAC use was collected at every follow-up visit. Adjusted proportional hazards modeling, including using landmarks of hospital discharge, 1 and 2 years after randomization, evaluated the effect of LAA occlusion on the risk of ischemic stroke or systemic embolism, according to OAC use. Adjusted proportional hazard modeling, with OAC use as a time-dependent covariate, was also performed to assess the effect of LAA occlusion, according to OAC use throughout the study. RESULTS At hospital discharge, 3027 patients (63.5%) were receiving a vitamin K antagonist, and 879 (18.5%) were receiving a non-vitamin K antagonist oral anticoagulant (direct OAC), with no difference in OAC use between treatment arms. There were 2887 (60.5%) patients who received OACs at all follow-up visits, 1401 (29.4%) who received OAC at some visits, and 472 (9.9%) who never received OACs. The effect of LAA occlusion on the risk of ischemic stroke or systemic embolism was consistent after discharge across all 3 groups: hazard ratios of 0.70 (95% CI, 0.51-0.96), 0.63 (95% CI, 0.43-0.94), and 0.76 (95% CI, 0.32-1.79), respectively. An adjusted proportional hazards model with OAC use as a time-dependent covariate showed that the reduction in stroke or systemic embolism with LAA occlusion was similar whether patients were receiving OACs or not. CONCLUSIONS The benefit of LAA occlusion was consistent whether patients were receiving OACs or not. LAA occlusion provides thromboembolism reduction in patients independent of OAC use.
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Affiliation(s)
- Stuart J. Connolly
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
| | - Jeff S. Healey
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
| | - Emilie P. Belley-Cote
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
| | - Kumar Balasubramanian
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
| | - Domenico Paparella
- University of Foggia, Italy (D.P.)
- Santa Maria Hospital, GVM Care & Research, Bari, Italy (D.P.)
| | - Katheryn Brady
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
| | - Wilko Reents
- Rhön-Klinikum Campus Bad Neustadt, Germany (W.R.)
| | | | - P.J. Devereaux
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
| | - Mukul Sharma
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
| | - Chinthanie Ramasundarahettige
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
| | - Richard P. Whitlock
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Ontario, Canada (S.J.C., J.S.H., E.P.B.-C., K. Balasubramanian, K. Brady, P.J.D., M.S., C.R., S.Y., R.P.W.)
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4
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Spence J, Belley-Côté E, Jacobsohn E, Lee SF, D’Aragon F, Avidan M, Mazer CD, Rousseau-Saine N, Rajamohan R, Pryor K, Klein R, Tan E(CH, Cameron M, Di Sante E, DeBorba E, Mustard M, Couture E, Zamper R, Law M, Djaiani G, Saha T, Choi S, Hedlin P, Pikaluk R, Lam WY, Deschamps A, Whitlock R, Dulong B, Devereaux P, Beaver C, Kloppenburg S, Oczkowski S, McIntyre WF, McFarling M, Lamy A, Vincent J, Connolly S. Benzodiazepine-Free Cardiac Anesthesia for Reduction of Postoperative Delirium (B-Free): A Protocol for a Multi-centre Randomized Cluster Crossover Trial. CJC Open 2023; 5:691-699. [PMID: 37744662 PMCID: PMC10516716 DOI: 10.1016/j.cjco.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/01/2023] [Indexed: 09/26/2023] Open
Abstract
Delirium is common after cardiac surgery and is associated with adverse outcomes. Administration of benzodiazepines before and after cardiac surgery is associated with delirium; guidelines recommend minimizing their use. Benzodiazepine administration during cardiac surgery remains common because of its recognized benefits. The Benzodiazepine-Free Cardiac Anesthesia for Reduction of Postoperative Delirium (B-Free) trial is a randomized cluster crossover trial evaluating whether an institutional policy of restricting intraoperative benzodiazepine administration (ie, ≥ 90% of patients do not receive benzodiazepines during cardiac surgery), as compared with a policy of liberal intraoperative benzodiazepine administration (ie, ≥ 90% of patients receive ≥ 0.03 mg/kg midazolam equivalent), reduces delirium. Hospitals performing ≥ 250 cardiac surgeries a year are included if their cardiac anesthesia group agrees to apply both benzodiazepine policies per their randomization, and patients are assessed for postoperative delirium every 12 hours in routine clinical care. Hospitals apply the restricted or liberal benzodiazepine policy during 12 to 18 crossover periods of 4 weeks each. Randomization for all periods takes place in advance of site startup; sites are notified of their allocated policy during the last week of each crossover period. Policies are applied to all patients undergoing cardiac surgery during the trial period. The primary outcome is the incidence of delirium at up to 72 hours after surgery. The B-Free trial will enroll ≥ 18,000 patients undergoing cardiac surgery at 20 hospitals across North America. Delirium is common after cardiac surgery, and benzodiazepines are associated with the occurrence of delirium. The B-Free trial will determine whether an institutional policy restricting the administration of benzodiazepines during cardiac surgery reduces the incidence of delirium after cardiac surgery. Clinicaltrials.gov registration number: NCT03928236 (First registered April 26, 2019).
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Affiliation(s)
- Jessica Spence
- Departments of Anesthesia and Critical Care and Health Research Methods, Evaluation, and Impact, McMaster University; and Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Emilie Belley-Côté
- Departments of Medicine (Cardiology and Critical Care), and Health Research Methods, Evaluation, and Impact, McMaster University, and Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Eric Jacobsohn
- Departments of Anesthesia and Perioperative Medicine and Medicine (Critical Care), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shun Fu Lee
- Department of Health Research Methods, Evaluation, and Impact, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada
| | - Frederick D’Aragon
- Département d'anesthésiologie, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael Avidan
- Department of Anesthesia, Washington University at St. Louis, St. Louis, Missouri, USA
| | - C. David Mazer
- Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Raja Rajamohan
- Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kane Pryor
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Rael Klein
- Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Matthew Cameron
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Emily Di Sante
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Erin DeBorba
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mary Mustard
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Etienne Couture
- Département d'anesthésiologie, Université Laval, Quebec City, Quebec, Canada
| | - Raffael Zamper
- Department of Anesthesia, University of Western Ontario, London, Ontario, Canada
| | - Michael Law
- Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada
| | - George Djaiani
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tarit Saha
- Department of Anesthesia, Queen's University, Kingston, Ontario, Canada
| | - Stephen Choi
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Hedlin
- Department of Anesthesia, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ryan Pikaluk
- Department of Anesthesia, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Wing Ying Lam
- Department of Anesthesia, University of Alberta, Edmonton, Alberta, Canada
| | - Alain Deschamps
- Département d'anesthésiologie, Université de Montréal, Montréal, Quebec, Canada
| | - Richard Whitlock
- Departments of Surgery (Cardiac Surgery) and Health Research Methods, Evaluation, and Impact, McMaster University, and Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Braden Dulong
- Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
| | - P.J. Devereaux
- Departments of Medicine (Cardiology and Critical Care), and Health Research Methods, Evaluation, and Impact, McMaster University, and Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
| | | | | | - Simon Oczkowski
- Department of Medicine (Critical Care), McMaster University, Hamilton, Ontario, Canada
| | - William Finlay McIntyre
- Department of Medicine (Cardiology), McMaster University, and Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Matthew McFarling
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Andre Lamy
- Departments of Surgery (Cardiac Surgery) and Health Research Methods, Evaluation, and Impact, McMaster University, Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jessica Vincent
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart Connolly
- Department of Medicine (Cardiology), McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada
| | - B-Free Investigators∗
- Departments of Anesthesia and Critical Care and Health Research Methods, Evaluation, and Impact, McMaster University; and Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
- Departments of Medicine (Cardiology and Critical Care), and Health Research Methods, Evaluation, and Impact, McMaster University, and Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
- Departments of Anesthesia and Perioperative Medicine and Medicine (Critical Care), University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Health Research Methods, Evaluation, and Impact, McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada
- Département d'anesthésiologie, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Anesthesia, Washington University at St. Louis, St. Louis, Missouri, USA
- Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Département d'anesthésiologie, Université de Montréal, Montréal, Quebec, Canada
- Department of Anesthesia, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
- Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
- Département d'anesthésiologie, Université Laval, Quebec City, Quebec, Canada
- Department of Anesthesia, University of Western Ontario, London, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, Queen's University, Kingston, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Department of Anesthesia, University of Alberta, Edmonton, Alberta, Canada
- Departments of Surgery (Cardiac Surgery) and Health Research Methods, Evaluation, and Impact, McMaster University, and Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
- Sheridan College, Brampton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine (Critical Care), McMaster University, Hamilton, Ontario, Canada
- Department of Medicine (Cardiology), McMaster University, and Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Departments of Surgery (Cardiac Surgery) and Health Research Methods, Evaluation, and Impact, McMaster University, Perioperative Research Division, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine (Cardiology), McMaster University, and Population Health Research Institute, Hamilton, Ontario, Canada
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Wang MK, Heo R, Meyre P, Park L, Blum S, McIntyre WF, Belley-Côté E, Birchenough L, Vuong K, Healey JS, Devereaux P, Lamy A, Conen D. Use of Anticoagulation Therapy in Patients With Perioperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-analysis. CJC Open 2022; 4:840-847. [PMID: 36254332 PMCID: PMC9568684 DOI: 10.1016/j.cjco.2022.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Michael Ke Wang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Corresponding author: Dr Michael Ke Wang, Population Health Research Institute, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada. Tel.: +1 289-426-2472; fax: +1 365-317-6272.
| | - Rachel Heo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pascal Meyre
- Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Louis Park
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Steffen Blum
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - William F. McIntyre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emilie Belley-Côté
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lauren Birchenough
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiven Vuong
- Faculty of Sciences, Western University, London, Ontario, Canada
| | - Jeff S. Healey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - P.J. Devereaux
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - André Lamy
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Conen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
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Ahmed M, Belley-Cote E, Qiu Y, Belesiotis P, Tao B, Wolf A, Kaur H, Ibrahim A, Healey JS, Conen D, Devereaux P, Whitlock R, McIntyre WF. RHYTHM VERSUS RATE CONTROL IN PATIENTS WITH POSTOPERATIVE ATRIAL FIBRILLATION FOLLOWING CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang MK, Meyre PB, Heo R, Devereaux P, Birchenough L, Whitlock R, McIntyre WF, Peter Chen YC, Ali MZ, Biancari F, Butt JH, Healey JS, Belley-Côté EP, Lamy A, Conen D. Short-term and Long-term Risk of Stroke in Patients With Perioperative Atrial Fibrillation After Cardiac Surgery: Systematic Review and Meta-analysis. CJC Open 2022; 4:85-96. [PMID: 35072031 PMCID: PMC8767142 DOI: 10.1016/j.cjco.2021.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022] Open
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8
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Wang MK, Binbraik Y, Riekki T, Devereaux P. MORBIDITY AND MORTALITY IN PULMONARY HYPERTENSION AFTER NON-CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Huynh JT, Healey JS, Um KJ, Vadakken ME, Rai AS, Conen D, Meyre P, Butt JH, Kamel H, Reza SJ, Nguyen ST, Oqab Z, Devereaux P, Balasubramanian K, Benz AP, Belley-Cote EP, McIntyre WF. Association Between Perioperative Atrial Fibrillation and Long-term Risks of Stroke and Death in Noncardiac Surgery: Systematic Review and Meta-analysis. CJC Open 2021; 3:666-674. [PMID: 34027371 PMCID: PMC8134907 DOI: 10.1016/j.cjco.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is frequently reported as a complication of noncardiac surgery. It is unknown whether new-onset perioperative AF is associated with an increased risk of stroke and death beyond the perioperative period. We performed a systematic review and meta-analysis to assess the long-term risks of stroke and mortality associated with new-onset perioperative AF after noncardiac surgery. METHODS MEDLINE and EMBASE were searched from inception to March 2020 for studies reporting on the association between perioperative AF and the risk of stroke and death occurring beyond 30 days after noncardiac surgery. Reference screening, study selection, data extraction, and quality assessment were performed in duplicate. Data were pooled using inverse variance-weighted random-effects models and presented as risk ratios (RRs). RESULTS From 7344 citations, we included 31 studies (3,529,493 patients). The weighted mean incidence of perioperative AF was 0.7%. During a mean follow-up of 28.1 ± 9.4 months, perioperative AF was associated with an increased risk of stroke (1.5 vs 0.9 strokes per 100 patient-years; RR: 2.9, 95% confidence interval [CI]: 2.1-3.9, I2 = 78%). Perioperative AF was also associated with a significantly higher risk of all-cause mortality (21.0 vs 7.6 deaths per 100 patient-years; RR: 1.8, 95% CI: 1.5-2.2, I2 = 94%). The pooled adjusted hazard ratios for stroke and all-cause mortality were 1.9 (95% CI: 1.6-2.2, I2 = 31%) and 1.5 (95% CI: 1.3-1.7, I2 = 20%), respectively. CONCLUSIONS Patients who had perioperative AF after noncardiac surgery had a higher long-term risk of stroke and mortality compared with patients who did not. Whether this risk is modifiable with oral anticoagulation therapy should be investigated.
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Affiliation(s)
- Jessica T. Huynh
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S. Healey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kevin J. Um
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Maria E. Vadakken
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Anand S. Rai
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - David Conen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Pascal Meyre
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Jawad H. Butt
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hooman Kamel
- Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Seleman J. Reza
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie T. Nguyen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Zardasht Oqab
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - P.J. Devereaux
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kumar Balasubramanian
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Alexander P. Benz
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Emilie P. Belley-Cote
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - William F. McIntyre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Holek M, Bdair F, Khan M, Walsh M, Devereaux P, Walter SD, Thabane L, Mbuagbaw L. Fragility of clinical trials across research fields: A synthesis of methodological reviews. Contemp Clin Trials 2020; 97:106151. [DOI: 10.1016/j.cct.2020.106151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022]
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11
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Whitlock RP, Dieleman JM, Belley-Cote E, Vincent J, Zhang M, Devereaux P, Kalkman CJ, van Dijk D, Yusuf S. The Effect of Steroids in Patients Undergoing Cardiopulmonary Bypass: An Individual Patient Meta-Analysis of Two Randomized Trials. J Cardiothorac Vasc Anesth 2020; 34:99-105. [DOI: 10.1053/j.jvca.2019.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 11/11/2022]
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12
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Fronczek J, Polok K, Devereaux P, Górka J, Archbold R, Biccard B, Duceppe E, Le Manach Y, Sessler D, Duchińska M, Szczeklik W. External validation of the Revised Cardiac Risk Index and National Surgical Quality Improvement Program Myocardial Infarction and Cardiac Arrest calculator in noncardiac vascular surgery. Br J Anaesth 2019; 123:421-429. [DOI: 10.1016/j.bja.2019.05.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/20/2019] [Accepted: 05/03/2019] [Indexed: 12/24/2022] Open
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13
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Khan JS, Hodgson N, Choi S, Reid S, Paul JE, Hong NJL, Holloway C, Busse JW, Gilron I, Buckley DN, McGillion M, Clarke H, Katz J, Mackey S, Avram R, Pohl K, Rao-Melacini P, Devereaux P. Perioperative Pregabalin and Intraoperative Lidocaine Infusion to Reduce Persistent Neuropathic Pain After Breast Cancer Surgery: A Multicenter, Factorial, Randomized, Controlled Pilot Trial. The Journal of Pain 2019; 20:980-993. [DOI: 10.1016/j.jpain.2019.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/29/2019] [Accepted: 02/23/2019] [Indexed: 11/15/2022]
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14
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Kavsak PA, Ainsworth C, Clark L, Devereaux P, Worster A. Four Different High-Sensitivity Cardiac Troponin Assays With Important Analytical Performance Differences. Can J Cardiol 2019; 35:796.e17-796.e18. [DOI: 10.1016/j.cjca.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/29/2022] Open
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15
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Shanthanna H, Paul J, Lovrics P, Vanniyasingam T, Devereaux P, Bhandari M, Thabane L. Satisfactory analgesia with minimal emesis in day surgeries: a randomised controlled trial of morphine versus hydromorphone. Br J Anaesth 2019; 122:e107-e113. [DOI: 10.1016/j.bja.2019.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/07/2019] [Accepted: 03/24/2019] [Indexed: 11/29/2022] Open
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16
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McIntyre WF, Mendoza PA, Belley‐Côté EP, Whitlock RP, Um KJ, Maystrenko N, Devereaux P, Conen D, Wong JA, Connolly SJ, Healey JS. Design and rationale of the atrial fibrillation occurring transiently with stress (AFOTS) follow-up cohort study. Clin Cardiol 2018; 41:1273-1280. [PMID: 30125047 PMCID: PMC6489868 DOI: 10.1002/clc.23053] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 01/17/2023] Open
Abstract
Atrial fibrillation occurring transiently with stress (AFOTS) describes the first detection of AF in a patient who is hospitalized for a non-cardiac medical illness or following non-cardiac surgery. Uncertainty exists whether episodes of AFOTS are due to reversible precipitants and will not recur after recovery, or if they are paroxysmal atrial fibrillation (AF) that is detected during inpatient cardiac monitoring. Previous studies have used retrospective, non-systematic and ultimately low-sensitivity protocols to investigate the recurrence of AF in patients with AFOTS. The prospective, multi-center, investigator-initiated AFOTS Follow-Up Cohort Study will enroll 138 case patients with AFOTS in the setting of non-cardiac surgery or medical illness, matched 1:1 with control patients for age, sex, stressor, and hospital unit. Participants will wear a 14-day ECG heart monitor at 1 and 6 months after hospital discharge. Over 12 months of follow-up, we will collect data regarding participant's medications, and clinical events. The primary endpoint is detection of 30 or more seconds of AF after hospital discharge. To date, 50% of the target sample has been enrolled. The study is expected to complete enrolment in mid-2019 and conclude 1 year later. The AFOTS follow-up study will employ a systematic protocol to detect AF and will provide a precise and valid estimate of AF recurrence following AFOTS. This study will establish whether patients with AFOTS have an increased propensity to AF after hospitalization as compared to matched controls and may inform the management of this population.
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Affiliation(s)
- William F. McIntyre
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Pablo A. Mendoza
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Emilie P. Belley‐Côté
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
- Division of Critical Care, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Richard P. Whitlock
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
- Division of Critical Care, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Division of Cardiac Surgery, Department of SurgeryMcMaster UniversityHamiltonOntarioCanada
| | - Kevin J. Um
- Population Health Research InstituteHamiltonOntarioCanada
- Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonOntarioCanada
| | | | - P.J. Devereaux
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - David Conen
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Jorge A. Wong
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Stuart J. Connolly
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
| | - Jeff S. Healey
- Division of Cardiology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
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Spence J, Belley-Côté E, Jacobsohn E, Syed S, Whitlock R, Lee S, Bangdiwala S, Arora R, Sarkaria A, MacIsaac S, Girling L, LeManach Y, Lamy A, Devereaux P, Connolly S. BENZODIAZEPINE-FREE CARDIAC ANESTHESIA FOR REDUCTION OF DELIRIUM (B-FREE): A TWO-CENTRE PILOT STUDY TO DETERMINE THE FEASIBILITY OF A MULTI-CENTRE, RANDOMIZED, CLUSTER CROSSOVER TRIAL. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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18
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Górka J, Polok K, Fronczek J, Górka K, Kózka M, Iwaszczuk P, Frołow M, Devereaux P, Biccard B, Musiał J, Szczeklik W. Myocardial Injury is More Common than Deep Venous Thrombosis after Vascular Surgery and is Associated with a High One Year Mortality Risk. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Górka J, Polok K, Fronczek J, Górka K, Kózka M, Iwaszczuk P, Frołow M, Devereaux P, Biccard B, Musiał J, Szczeklik W. Myocardial Injury is More Common than Deep Venous Thrombosis after Vascular Surgery and is Associated with a High One Year Mortality Risk. Eur J Vasc Endovasc Surg 2018; 56:264-270. [DOI: 10.1016/j.ejvs.2018.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 02/03/2018] [Indexed: 12/21/2022]
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20
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Dvirnik N, Belley-Cote E, Hanif H, Devereaux P, Lamy A, Dieleman J, Vincent J, Whitlock R. Steroids in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth 2018; 120:657-667. [DOI: 10.1016/j.bja.2017.10.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 10/16/2017] [Accepted: 10/26/2017] [Indexed: 11/27/2022] Open
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21
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Duceppe E, Yusuf S, Tandon V, Rodseth R, Biccard BM, Xavier D, Szczeklik W, Meyhoff CS, Franzosi MG, Vincent J, Srinathan SK, Parlow J, Magloire P, Neary J, Rao M, Chaudhry NK, Mayosi B, de Nadal M, Popova E, Villar JC, Botto F, Berwanger O, Guyatt G, Eikelboom JW, Sessler DI, Kearon C, Pettit S, Connolly SJ, Sharma M, Bangdiwala SI, Devereaux P. Design of a Randomized Placebo-Controlled Trial to Assess Dabigatran and Omeprazole in Patients with Myocardial Injury after Noncardiac Surgery (MANAGE). Can J Cardiol 2018; 34:295-302. [DOI: 10.1016/j.cjca.2018.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022] Open
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22
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McClure G, Belley-Cote E, Harlock J, Lamy A, Stacey M, Devereaux P, Whitlock R. P6064Steroids in cardiac surgery (SIRS): infection substudy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Belley-Cote E, Whitlock R, Ulic D, Honarmand K, Khalifa A, McClure G, Alshamsi F, D'Aragon F, Rochwerg B, Duan E, Savija N, Karachi T, Lamontagne F, Devereaux P, Cook D. P2748The PROTROPICS feasibility: prognostic value of elevated troponins in critical illness. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Beattie WS, Wijeysundera DN, Chan MT, Peyton PJ, Leslie K, Paech MJ, Devereaux P, Sessler DI, Wallace S, Myles PS. Survival After Isolated Post-Operative Troponin Elevation. J Am Coll Cardiol 2017; 70:907-908. [DOI: 10.1016/j.jacc.2017.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 04/30/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
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25
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Spence J, Bosch J, Sharma M, Cukierman-Yaffe T, Canavan M, Belley-Cote E, Whitlock R, Devereaux P, Lamy A. 2202Predictors of cognitive decline after cardiac surgery: an evaluation of the CABG off or on pump revascularization study (CORONARY) cohort. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Abbott T, Pearse R, Archbold R, Wragg A, Kam E, Ahmad T, Khan A, Niebrzegowska E, Rodseth R, Devereaux P, Ackland G. Association between preoperative pulse pressure and perioperative myocardial injury: an international observational cohort study of patients undergoing non-cardiac surgery. Br J Anaesth 2017; 119:78-86. [DOI: 10.1093/bja/aex165] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2017] [Indexed: 01/23/2023] Open
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27
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Górka J, Polok K, Iwaniec T, Górka K, Włudarczyk A, Fronczek J, Devereaux P, Eikelboom J, Musiał J, Szczeklik W. Altered preoperative coagulation and fibrinolysis are associated with myocardial injury after non-cardiac surgery. Br J Anaesth 2017; 118:713-719. [DOI: 10.1093/bja/aex081] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 02/05/2023] Open
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Belcher AW, Khanna AK, Leung S, Naylor AJ, Hutcherson MT, Nguyen BM, Makarova N, Sessler DI, Devereaux P, Saager L. Long-Acting Patient-Controlled Opioids Are Not Associated With More Postoperative Hypoxemia Than Short-Acting Patient-Controlled Opioids After Noncardiac Surgery. Anesth Analg 2016; 123:1471-1479. [DOI: 10.1213/ane.0000000000001534] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Spence J, Belley-Cote E, Ma K, Donald S, Centofanti J, Hussain S, Gupta S, Devereaux P, Whitlock R. EFFICACY AND SAFETY OF INHALED ANESTHETIC FOR POSTOPERATIVE SEDATION DURING MECHANICAL VENTILATION IN ADULT CARDIAC SURGERY PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bessissow A, Agzarian J, Srinathan S, Schneider L, Devereaux P, Neary J, Dechert W, Gandy L, Finley C, Hanna W, Schieman C, Shargall Y. F-073THE EFFECT OF COLCHICINE ADMINISTRATION ON POSTOPERATIVE PLEURAL EFFUSION FOLLOWING THORACIC SURGERY: A RANDOMIZED, DOUBLE BLIND, PLACEBO-CONTROLLED, FEASIBILITY PILOT STUDY. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mrkobrada M, Hill M, Chan M, Sigamani A, Cowan D, Kurz A, Sessler D, Jacka M, Graham M, Dasgupta M, Dunlop V, Emery D, Gulka I, Guyatt G, Heels-Ansdell D, Murkin J, Pettit S, Sahlas D, Sharma M, Sharma M, Srinathan S, St John P, Tsai S, Gelb A, O’Donnell M, Siu D, Chiu P, Sharath V, George A, Devereaux P. Covert stroke after non-cardiac surgery: a prospective cohort study. Br J Anaesth 2016; 117:191-7. [DOI: 10.1093/bja/aew179] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/13/2022] Open
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Devereaux P, Eikelboom J. Insights into myocardial infarction after noncardiac surgery in patients with a prior coronary artery stent. Br J Anaesth 2016; 116:584-6. [DOI: 10.1093/bja/aew111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Khanna A, Sessler D, Sun Z, Naylor A, You J, Hesler B, Kurz A, Devereaux P, Saager L. Using the STOP-BANG questionnaire to predict hypoxaemia in patients recovering from noncardiac surgery: a prospective cohort analysis. Br J Anaesth 2016; 116:632-640. [DOI: 10.1093/bja/aew029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Devaraj U, Rajagopala S, Kumar A, Ramachandran P, D'Souza G, Devereaux P. Undiagnosed obstructive sleep apnea and post-operative outcomes: A prospective observational study from tertiary care center. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.02.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Belley-Cote E, Lamy A, Vincent J, Kavsak P, Ou Y, Zhang M, Devereaux P, Whitlock R. AN EVENT DRIVEN MYOCARDIAL INFARCTION DEFINITION USING TROPONINS AFTER CORONARY ARTERY BYPASS SURGERY IN THE CORONARY TRIAL. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Belley-Cote E, Lamy A, Tagarakis G, Ou Y, Vincent J, Kavsak P, Zhang M, Devereaux P, Whitlock R. AN EVALUATION OF THE INCIDENCE AND PROGNOSIS OF POST CORONARY ARTERY BYPASS GRAFTING MYOCARDIAL INFARCTION ACCORDING TO DIFFERENT DEFINITIONS IN THE CORONARY TRIAL. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Stevens L, Noiseux N, Devereaux P, Yusuf S, Eikelboom J, Cheung A, Whitlock R, Ou Y, Pogue J, Lamy A. BLOOD TRANSFUSIONS ARE ASSOCIATED WITH WORSE OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Walsh M, Srinathan SK, McAuley DF, Mrkobrada M, Levine O, Ribic C, Molnar AO, Dattani ND, Burke A, Guyatt G, Thabane L, Walter SD, Pogue J, Devereaux P. The statistical significance of randomized controlled trial results is frequently fragile: a case for a Fragility Index. J Clin Epidemiol 2014; 67:622-8. [DOI: 10.1016/j.jclinepi.2013.10.019] [Citation(s) in RCA: 365] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 09/28/2013] [Accepted: 10/07/2013] [Indexed: 01/29/2023]
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Whitlock R, Teoh K, Vincent J, Devereaux P, Lamy A, Paparella D, Zuo Y, Sessler DI, Shah P, Villar JC, Karthikeyan G, Urrútia G, Alvezum A, Zhang X, Abbasi SH, Zheng H, Quantz M, Yared JP, Yu H, Noiseux N, Yusuf S. Rationale and design of the steroids in cardiac surgery trial. Am Heart J 2014; 167:660-5. [PMID: 24766975 DOI: 10.1016/j.ahj.2014.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/30/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Steroids may improve outcomes in high-risk patients undergoing cardiac surgery with the use of cardiopulmonary bypass (CBP). There is a need\ for a large randomized controlled trial to clarify the effect of steroids in such patients. METHODS We plan to randomize 7,500 patients with elevated European System for Cardiac Operative Risk Evaluation who are undergoing cardiac surgery with the use of CBP to methylprednisolone or placebo. The first coprimary outcome is 30-day all-cause mortality, and the most second coprimary outcome is a composite of death, MI, stroke, renal failure, or respiratory failure within 30 days. Other outcomes include a composite of MI or mortality at 30 days, new onset atrial fibrillation, bleeding and transfusion requirements, length of intensive care unit stay and hospital stay, infection, stroke, wound complications, gastrointestinal complications, delirium, postoperative insulin use and peak blood glucose, and all-cause mortality at 6 months. RESULTS As of October 22, 2013, 7,034 patients have been recruited into SIRS in 82 centers from 18 countries. Patient's mean age is 67.3 years, and 60.4% are male. The average European System for Cardiac Operative Risk Evaluation is 7.0 with 22.1% having an isolated coronary artery bypass graft procedure, and 66.1% having a valve procedure. CONCLUSIONS SIRS will lead to a better understanding of the safety and efficacy of prophylactic steroids for cardiac surgery requiring CBP.
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Chow C, Chan M, Halliwell R, Kovoor P, Lee V, Mooney J, Thiagalingam A, Bompoint S, Devereaux P, Hillis G. O062 Smoking and perioperative cardiovascular and medical outcomes in patients undergoing non-cardiac surgery. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Leslie K, Myles P, Devereaux P, Williamson E, Rao-Melancini P, Forbes A, Xu S, Foex P, Pogue J, Arrieta M, Bryson G, Paul J, Paech M, Merchant R, Choi P, Badner N, Peyton P, Sear J, Yang H. Reply from the authors. Br J Anaesth 2014. [DOI: 10.1093/bja/aet576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Leslie K, Myles P, Devereaux P, Williamson E, Rao-Melancini P, Forbes A, Xu S, Foex P, Pogue J, Arrieta M, Bryson G, Paul J, Paech M, Merchant R, Choi P, Badner N, Peyton P, Sear J, Yang H. Reply from the authors. Br J Anaesth 2014; 112:393-394. [PMID: 24571040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Leslie K, Myles P, Devereaux P, Williamson E, Rao-Melancini P, Forbes A, Xu S, Foex P, Pogue J, Arrieta M, Bryson G, Paul J, Paech M, Merchant R, Choi P, Badner N, Peyton P, Sear J, Yang H. Neuraxial block, death and serious cardiovascular morbidity in the POISE trial. Br J Anaesth 2013; 111:382-90. [PMID: 23611915 DOI: 10.1093/bja/aet120] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This post hoc analysis aimed to determine whether neuraxial block was associated with a composite of cardiovascular death, non-fatal myocardial infarction (MI) and non-fatal cardiac arrest within 30 days of randomization in POISE trial patients. METHODS A total of 8351 non-cardiac surgical patients at high risk of cardiovascular complications were randomized to β-blocker or placebo. Neuraxial block was defined as spinal, lumbar or thoracic epidural anaesthesia. Logistic regression, with weighting using estimated propensity scores, was used to determine the association between neuraxial block and primary and secondary outcomes. RESULTS Neuraxial block was associated with an increased risk of the primary outcome [287 (7.3%) vs 229 (5.7%); odds ratio (OR), 1.24; 95% confidence interval (CI), 1.02-1.49; P=0.03] and MI [230 (5.9%) vs 177 (4.4%); OR, 1.32; 95% CI, 1.07-1.64; P=0.009] but not stroke [23 (0.6%) vs 32 (0.8%); OR, 0.76; 95% CI, 0.44-1.33; P=0.34], death [96 (2.5%) vs 111 (2.8%); OR, 0.87; 95% CI, 0.65-1.17; P=0.37] or clinically significant hypotension [522 (13.4%) vs 484 (12.1%); OR, 1.13; 95% CI, 0.99-1.30; P=0.08]. Thoracic epidural with general anaesthesia was associated with a worse primary outcome than general anaesthesia alone [86 (12.1%) vs 119 (5.4%); OR, 2.95; 95% CI, 2.00-4.35; P<0.001]. CONCLUSIONS In patients at high risk of cardiovascular morbidity, neuraxial block was associated with an increased risk of adverse cardiovascular outcomes, which could be causal or because of residual confounding.
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Affiliation(s)
- K Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.
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Lamy A, Devereaux P, Prabhakaran D, Taggart D, Hu S, Paolasso E, Straka Z, Piegas L, Akar R, Ou N, Chrolavicius S, Yusuf S. 901 Importance of Risk Stratification to Explain International Variations in Results of the Coronary Trial (Off-Pump Vs. On-Pump Cabg Surgery) — the Canadian Results. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kavsak P, Hill S, You J, Oremus M, Devereaux P, Jaffe A, Worster A. Early serial measurements of myeloperoxidase, a sensitive cardiac troponin I and high-sensitivity cardiac troponin T in patients presenting within 6hours of chest pain onset. Clin Biochem 2012. [DOI: 10.1016/j.clinbiochem.2012.07.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux P, Elbourne D, Egger M, Altman DG. Erratum to: “CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials” [J Clin Epidemiol 2010;63(8):e1–37]. J Clin Epidemiol 2012. [DOI: 10.1016/j.jclinepi.2011.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kavsak PA, Allen LC, Apple FS, Booth RA, Chan PC, Delvin E, Fraser A, Fu L, Gornall D, Collier C, Hill S, Hoffman B, Huang Y, Lavoie J, Lou A, Mattman A, McQueen M, Meng QH, Oleschuk C, Pudek M, Randell E, Sohn KY, Thorlacius L, Yip PM, Dahdah N, Devereaux P, Dhesy-Thind S, Hotte SJ, Worster A. Cardiac troponin testing in the acute care setting: Ordering, reporting, and high sensitivity assays—An update from the Canadian society of clinical chemists (CSCC). Clin Biochem 2011; 44:1273-7. [DOI: 10.1016/j.clinbiochem.2011.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
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Kavsak P, Walsh M, Srinathan S, Thorlacius L, Buse G, Botto F, Pettit S, McQueen M, Hill S, Thomas S, Mrkobrada M, Devereaux P. The prevalence of preoperative elevations in troponin T above the 99th percentile using the troponin T high sensitive assay in patients undergoing noncardiac surgery. Clin Biochem 2011. [DOI: 10.1016/j.clinbiochem.2011.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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49
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Rao R, Devereaux P, Graham M, Natarajan M, Valettas N, Sheth T. 244 Angiographic features of perioperative myocardial infarction (POMI). Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sohn KY, Phan K, Hill S, Worster A, You J, Oremus M, Devereaux P, Jaffe A, Kavsak P. Comparison of angiogenic growth factors assays using a research mulitplex platform versus clinical platforms in patients with chest pain. Clin Biochem 2011. [DOI: 10.1016/j.clinbiochem.2011.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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