Preoperative cardiac troponin level is associated with all-cause mortality of liver transplantation recipients

<div><p>This study was aimed to evaluate the association between preoperative high-sensitivity cardiac troponin I (hs-cTnI) level and mortality in patients undergoing liver transplantation (LT). From January 2011 to May 2016, preoperative hs-cTnI level was measured in consecutive 487 patients scheduled for LT. Patients with elevated preoperative hs-cTnI were compared with those who had normal level. The primary outcome was all-cause death in follow-up period of 30 days to 1 year after operation. Of the 487 patients, 58 (11.9%) had elevated preoperative hs-cTnI and 429 (88.1%) had normal preoperative hs-cTnI. In multivariate analysis, the rate of 1-year mortality and 30-day mortality were higher in elevated preoperative hs-cTnI group (hazard ratio [HR], 3.69; confidence interval [CI] 95%, 1.83–7.42; p < 0.001, HR, 6.61; CI, 1.91–22.82; p = 0.003, respectively). After adjustment with inverse probability weighting (IPW), the incidence of 1-year mortality and 30-day mortality were higher in elevated group (HR, 4.66; CI, 3.56–6.1; p < 0.001, HR, 10.31; CI, 6.39–16.66; p < 0.001, respectively). In conclusion, this study showed that in patients who underwent LT, elevation of preoperative hs-cTnI level was associated with 1-year mortality and 30-day mortality.</p></div

Preoperative variables associated with clinical outcome.

<p>Preoperative variables associated with clinical outcome.</p

The Kaplan-Meier Curves for the hs-cTnI elevated and normal hs-cTnI group.

<p>Curves for (A) all-cause death in 1-year, and (B) all-cause death in 30 days.</p

Baseline characteristics.

<p>Baseline characteristics.</p

Subgroup analysis of deceased donor type, diabetes mellitus, encephalopathy, preoperative transfusion, intraoperative dopamine use and intraoperative norepinephrine use for all-cause death in 1-year.

<p>Subgroup analysis of deceased donor type, diabetes mellitus, encephalopathy, preoperative transfusion, intraoperative dopamine use and intraoperative norepinephrine use for all-cause death in 1-year.</p

Association between perioperative β-blocker use and clinical outcome of non-cardiac surgery in coronary revascularized patients without severe ventricular dysfunction or heart failure

<div><p>Perioperative use of β-blocker has been encouraged in patients undergoing non-cardiac surgery despite weak evidence, especially in patients without left ventricular systolic dysfunction (LVSD) or heart failure (HF). This study evaluated the effects of perioperative β-blocker on clinical outcomes after non-cardiac surgery among coronary revascularized patients without LVSD or HF. Among a total of 503 patients with a history of coronary revascularization (either by percutaneous coronary intervention or coronary arterial bypass grafts) undergoing non-cardiac surgery, those without severe LVSD defined by ejection fraction over 30% or HF were evaluated. The primary outcome was a composite of death, myocardial infarction, repeat revascularization, and stroke during 1-year follow-up. Perioperative β-blocker was used in 271 (53.9%) patients. During 1-year follow-up, we found no significant difference in primary outcome between the two groups on multivariate analysis (hazard ratio [HR], 1.01; confidence interval [CI] 95%, 0.56–1.82; P = 0.963). The same result was shown in propensity-matched population (HR, 1.25; CI 95%, 0.65–2.38; P = 0.504). In coronary revascularized patients without severe LVSD or HF, perioperative β-blocker use may not be associated with postoperative clinical outcome of non-cardiac surgery. Larger registry data is needed to support this finding.</p></div

Subgroup analysis of history of myocardial infarction, high-risk surgery, ejection fraction over 50%, coronary arterial bypass grafting as revascularization type, multivessel disease and chronic kidney disease for major adverse cardiovascular and cerebral events on 1-year follow-up.

<p>Subgroup analysis of history of myocardial infarction, high-risk surgery, ejection fraction over 50%, coronary arterial bypass grafting as revascularization type, multivessel disease and chronic kidney disease for major adverse cardiovascular and cerebral events on 1-year follow-up.</p

Kaplan-Meier Curves for major adverse cardiovascular and cerebral events during 1-year follow-up in the entire (A) and propensity-matched (B) populations.

<p>Kaplan-Meier Curves for major adverse cardiovascular and cerebral events during 1-year follow-up in the entire (A) and propensity-matched (B) populations.</p

Baseline characteristics.

<p>Baseline characteristics.</p

Clinical outcomes in entire population.

<p>Clinical outcomes in entire population.</p