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1-year mortality after myocardial injury in COVID-19 patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial injury is a known complication of COVID-19 and is related to a worse prognosis on admission. However, its impact on 1-year mortality is unknown.
Methods
Retrospective cohort study with patients admitted to intensive care and confirmed diagnosis of COVID-19 by RT-PCR and with at least one measurement of troponin during hospitalization. The study period was from March/2020 to June/2021. Clinical characteristics and the occurrence of myocardial were assessed between deaths and survivors using the chi-square test and Student's t-test. Variables with p<0.01 in the univariate analysis were included in the Cox regression model to identify predictor variables of 1-year mortality.
Results
1037 patients were included, with a mean follow-up of 1.06±0.58 years, mean age = 59.9±16.2 years, and 62.7% men. The prevalence of myocardial injury was 42.8% and occurred 204 deaths (19.7%). In the univariate analysis, the variables associated with 1-year mortality were: myocardial injury (OR 7.5; CI95% 5.2–10.9), age >60 years (OR 5.65; CI95% 3.9–8.2), arterial hypertension (OR 2.8; CI95% 2.0–3.9), diabetes (OR 2.3; CI95% 1.6–3.1), chronic kidney failure (OR 3.9; CI95% 2.2–6.8), dementia (OR 1.8; CI95% 1.2–2.6) and mechanical ventilation (OR 50.5; CI95% 33.9–77.3). In Cox regression, the predictor variables were: myocardial injury (HR 2.4; CI95% 1.7–3.5), age >60 years (HR 2.5; CI95% 1.8–3.6), chronic kidney disease (HR 1.9; CI95% 1.2–2.9), dementia (HR 3.2; CI95% 2.1–5.0) and mechanical ventilation (HR 17.5; CI95% 12.2–25.2).
Conclusion
In patients admitted to intensive care by COVID-19, the detection of myocardial injury more than doubled the risk of death in 1 year.
Funding Acknowledgement
Type of funding sources: None.
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Perioperative myocardial injury after non-cardiac surgery: long-term mortality according to cardiovascular risk. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Perioperative Myocardial injury that occurs after non-cardiac surgery (MINS) is prevalent and increases mortality in 30 days. However, few studies have assessed the impact of cardiovascular risk and MINS in long-term mortality.
Methods
Retrospective study including all non-cardiac surgery patients admitted to a postoperative care unit who stayed at least one night in this unit and had at least one measurement of high-sensitive cardiac troponin. The study period was from January/2011 to December/2019, ensuring a minimum follow-up of 2 years. The criteria for defining a high cardiovascular risk patient (HCR) were: history of established cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease), diabetes, chronic kidney disease with clearance <60 ml/min, or presence of, at least, 3 risk factors (hypertension, smoking, dyslipidemia, or age >65 years). The population was divided into 4 subgroups according to the presence of HCR and elevated troponin. Clinical characteristics and the occurrence of MINS were assessed between deaths and survivors using the chi-squared test and Student's t-test. Variables with p<0.01 in the univariate model and the subgroups were included in the Cox regression model to identify predictor variables.
Results
2230 patients were included, with a mean follow-up of 6.21±2.74 years, mean age = 63.7±16.2 years, and 55.6% women. The prevalence of MINS was 9.4%. There were 556 deaths (24.9%). Group 1 (no MINS and no HCR) had 1521 patients (68.2%); Group 2, 126 patients (5.7%); Group 3, 500 patients (22.4%) and Group 4, 83 patients (3.7%). In the univariate analysis, the following variables were associated with death: age, arterial hypertension, BMI, previous myocardial infarction, urgent surgery, dementia, peripheral artery disease (PAD), and atrial fibrillation. These variables were included in Cox's regression model with the predefined subgroups and the predictive variables of all-cause death were: Group 2 (HR 2.12; 95% CI: 1.56–2.87), Group 4 (HR 2.50; 95% CI: 1.79–3.50), previous myocardial infarction (HR 1.44; 95% CI: 1.08–1.93); dementia (HR 2.90; 95% CI: 2.15–3.92), PAD (HR 1.91; 95% CI: 1.27–2.90) and age (HR 1.05; 95% CI: 1.04–1.06).
Conclusion
Cardiovascular risk did not influence long-term mortality in patients undergoing non-cardiac surgery, demonstrating that myocardial injury is one of the main predictors of death independently of cardiovascular risk.
Funding Acknowledgement
Type of funding sources: None.
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151: Analgesic Provision to Pediatric Patients with Acute Abdominal Pain in the Emergency Department: A Survey of Canadian Pediatric Emergency Physicians. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Silica-Based Micron-Sized Iron Oxide Particles for Detection and Loco-Regional Stimulation of Transplanted Liver Cells. Transplantation 2012. [DOI: 10.1097/00007890-201211271-01986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nosocomial pneumonia and the main victim: the older person – measures for ventilator-associated pneumonia control. Crit Care 2009. [PMCID: PMC4085440 DOI: 10.1186/cc7842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Differenzielle Therapieverläufe in der stationären Psychotherapie: Eine störungsübergreifende Differenzierung von Verlaufstypen. Psychother Psychosom Med Psychol 2008. [DOI: 10.1055/s-2008-1061574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstracts of presentations to the Annual Meetings of the Canadian Society of Colon and Rectal Surgeons Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons: Canadian Surgery Forum, London, Ont., Sept. 19 to 22, 2002. Can J Surg 2002; 45:3-26. [PMID: 37381180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
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