Incidence of myocardial injury in patients submitted to carotid endarterectomy

Autores da FMUP

• José Paulo Alves Vieira De Andrade

  Autor

• Bernardo Manuel De Sousa Pinto

  Autor

• João Manuel Palmeira Rocha Neves

  Autor

Participantes de fora da FMUP

• Pereira-Macedo, J
• Silva, AF
• Duarte-Gamas, L

Unidades de investigação

• Biomedicina

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina da Comunidade, Informação e Decisão em Saúde

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

<jats:p> Summary: Myocardial injury following noncardiac surgery (MINS) is associated with higher mortality and major adverse cardiovascular event rates in the short- and long-term in patients undergoing carotid endarterectomy (CEA). However, its incidence is still unclear in this subset of patients. Therefore, this systematic review with meta-analysis aims to determine the incidence of MINS in patients undergoing CEA. Three electronic databases MEDLINE, Scopus, and Web of Science were used to search for studies assessing the occurrence of MINS in the postoperative setting of patients undergoing CEA. The incidence of MINS was pooled by random-effects meta-analysis, with sources of heterogeneity being explored by meta-regression and subgroup analysis (general anesthesia vs. regional anesthesia). Assessment of studies? quality was performed using National Heart, Lung, and Blood Institute Study Quality Assessment Tool, and Risk of Bias 2 tools. Twenty studies were included, with a total of 117,933 participants. Four of them were RCTs, while the remaining were cohort studies. All observational cohorts had an overall high risk of bias, except for Pereira Macedo et al. Three of them had repeated population, thus only data from the most recent one was considered. On the other hand, all RCT had an overall low risk of bias. In patients under regional anesthesia, the incidence of MINS in primary studies ranged between 2% and 15.3%, compared to 0?42.5% for general anesthesia. The meta-analytical incidence of MINS after CEA was of 6.3% [95% CI 2.0?10.6%], but severe heterogeneity was observed (I<jats:sup>2</jats:sup>=99.1%). MINS appears to be relatively common among patients undergoing CEA. The observed severe heterogeneity points to the need for further larger studies adopting consistent definitions of MINS and equivalent cut-off values. </jats:p>

Keywords

• Carotid Stenosis; Endarterectomy, Carotid; Humans; Incidence; Postoperative Complications; Risk Factors; Treatment Outcome; antithrombocytic agent; creatine kinase MB; troponin; cardiovascular disease; carotid artery stenting; carotid endarterectomy; cerebrovascular accident; cohort analysis; comorbidity; coronary artery disease; cross-sectional study; diabetes mellitus; dyslipidemia; general anesthesia; heart muscle injury; human; hypertension; incidence; meta analysis; mortality; Preferred Reporting Items for Systematic Reviews and Meta-Analyses; prevalence; randomized controlled trial (topic); regional anesthesia; retrospective study; Review; sensitivity analysis; systematic review; carotid stenosis; diagnostic imaging; incidence; postoperative complication; risk factor; treatment outcome