Noncardiac Patients Research Articles

Analysis of the Knowledge Level of the Surgical Residents Regarding the Preoperative Assessment of the Adult Elective Non-cardiac Surgery Patients with Specific Clinical Conditions

Analysis of the Knowledge Level of the Surgical Residents Regarding the Preoperative Assessment of the Adult Elective Non-cardiac Surgery Patients with Specific Clinical Conditions

Evaluation of Parenteral Potassium Supplementation in Pediatric Patients.

The primary objective was to evaluate the effect of parenteral potassium chloride (KCl) supplementation on potassium (K+) concentrations in a non-cardiac pediatric population. Secondary outcomes were to identify variables that may influence response to KCl supplementation (i.e., change in K+ concentration after KCl administration) and assess the incidence of hyperkalemia. This single-center, retrospective study evaluated infants and children who received parenteral KCl supplementation of 0.5 or 1 mEq/kg between January 2017 and December 2019. The study included 102 patients with a median age of 1 year (IQR, 0.4-3.9) and weight of 9.1 kg (IQR, 4.9-14.2) who received 288 parenteral KCl administrations. One hundred seventy-three administrations were in the 1 mEq/kg group, and 115 administrations were in the 0.5 mEq/kg group. The median changes in K+ were 0.8 and 0.5 mEq/L in the 1 mEq/kg and 0.5 mEq/kg groups, respectively. Patients who had a repeat K+ concentration within 4 hours of the end of a 1 to 2-hour infusion had a higher median change in K+ compared with those who had a concentration drawn after this time frame (0.8 vs 0.6 mEq/L; p < 0.01). There is a paucity of data on the correlation between parenteral KCl supplementation and change in K+ concentrations in pediatric patients. Our study demonstrated an association between KCl supplementation doses of 1 and 0.5 mEq/kg and changes in K+ of 0.8 and 0.5 mEq/L, respectively, in non-cardiac pediatric patients, with low observed incidence of hyperkalemia.

β-Blockade before Noncardiac Surgery: The Devil Is in the Details.

β-Blockade before Noncardiac Surgery: The Devil Is in the Details.

Association of Mean Platelet Volume with Acute Coronary Syndrome: A Case–Control Study

Abstract Background: Acute coronary syndrome (ACS) is a group of symptoms associated with acute myocardial ischemia and is one of the major causes of morbidity and mortality across the world. Its primary etiology is atherosclerosis which is crucially dependent on platelets, and hence, mean platelet volume (MPV) could be a new biomarker for predicting or diagnosing ACS. Our study aims to measure the MPV in patients of ACS and compares it with patients of noncardiac chest pain to evaluate its usefulness as a new marker for ACS. Materials and Methods: A case–control study with 50 cases and 50 controls was carried out in SSG Hospital, Vadodara, over a period of 1 year (November 2016–November 2017). ACS patients were identified according to inclusion and exclusion criteria and their MPV was compared to that of noncardiac chest pain patients. Results: The cases had a higher MPV as compared to the control group, with both males and females being affected, but a stronger association was seen in case of males. Conclusions: Raised MPV has shown significant association with ACS and the test has reasonable sensitivity and specificity, which warrants larger scale studies to confirm its utility as a biomarker for ACS.

Comparing The Common Femoral Vein Diameter and The Inferior Vena Cava Diameter as A Predictor of Post-Induction Hypotension in Non-Cardiac Patients Undergoing General Anesthesia

Comparing The Common Femoral Vein Diameter and The Inferior Vena Cava Diameter as A Predictor of Post-Induction Hypotension in Non-Cardiac Patients Undergoing General Anesthesia

Hydrogen Gas Treatment Improves Postoperative Delirium and Cognitive Dysfunction in Elderly Noncardiac Patients.

Purpose: Postoperative delirium is a state of acute brain dysfunction characterized by fluctuating mental status that affects millions of patients each year. We used prophylactic inhalation of hydrogen gas in elderly patients undergoing elective surgery to compare their occurrence of postoperative delirium with that of controls. Methods: A total of 184 patients aged ≥ 65 years were enrolled and randomized into either a control group or a hydrogen inhalation group. The quality of sleep was assessed 1 day before and 1, 3, and 7 days after surgery at 8 A.M. The Confusion Assessment Method (CAM) was used as a screening tool for delirium and assessed the patients’ state of consciousness 1−7 days after surgery. Results: Postoperative delirium occurred in 17 (24%) of 70 patients without hydrogen inhalation and in 10 (12%) of 83 patients after hydrogen inhalation. The incidence of delirium was decreased in the hydrogen group. No significant differences were found between length of stay in hospital after surgery and sleep quality at 1, 3, and 7 days postoperatively between the two groups. The numerical rating scale (NRS) pain scores were higher in the hydrogen group (4.08 ± 1.77) than the control group (3.54 ± 1.77) on day 1 (p < 0.05); however, the mean difference between the two groups was small (1 to 1.6). There were no significant differences on day 3 and 7. The postoperative C-reactive protein level was significantly lower in the hydrogen group than the control group. Conclusions: This study suggests that hydrogen inhalation can prevent postoperative delirium in elderly noncardiac patients by reducing the inflammatory response.

Contribution of intraoperative electroencephalogram suppression to frailty-associated postoperative delirium: mediation analysis of a prospective surgical cohort

BackgroundFrailty is a risk factor for postoperative delirium (POD), and has led to preoperative interventions that have reduced, but not eliminated, the risk. We hypothesised that EEG suppression, another risk factor for POD, mediates some of the frailty risk for POD. MethodsA prospective cohort study enrolled patients aged 65 yr or older, scheduled for noncardiac surgery under total intravenous anaesthesia. Frailty was assessed using the FRAIL scale. Cumulative duration of EEG suppression, defined as an amplitude between –5 and 5 μV for >0.5 s during anaesthesia, was measured. POD was diagnosed by either confusion assessment method (CAM), CAM-ICU, or medical records. The severity of POD was assessed using the Delirium Rating Scale – Revised-98 (DRS). Mediation analysis was used to estimate the relationships between frailty, EEG suppression, and severity of POD. ResultsAmong 252 enrolled patients, 51 were robust, 129 were prefrail, and 72 were frail. Patients classified as frail had higher duration of EEG suppression than either the robust (19 vs 0.57 s, P<0.001) or prefrail groups (19 vs 3.22 s, P<0.001). Peak delirium score was higher in the frail group than either the robust (17 vs 15, P<0.001) or prefrail groups (17 vs 16, P=0.007). EEG suppression time mediated 24.2% of the frailty–DRS scores association. ConclusionEEG suppression time mediated a statistically significant portion of the frailty–POD association in older noncardiac surgery patients. Trials directed at reducing EEG suppression time could result in intraoperative interventions to reduce POD in frail patients. Clinical trial registrationChiCTR2000041092 (Chinese Clinical Trial Registry).

Editor's Choice Articles for December.

Editor's Choice Articles for December.

Management and Prognosis of Cardiac Metastatic Merkel Cell Carcinoma: A Case-Control Study and Literature Review.

Merkel cell carcinoma (MCC), an aggressive neuroendocrine skin cancer, has a high rate (20%) of distant metastasis. Within a prospective registry of 582 patients with metastatic MCC (mMCC) diagnosed between 2003-2021, we identified 9 (1.5%) patients who developed cardiac metastatic MCC (mMCC). We compared overall survival (OS) between patients with cardiac and non-cardiac metastases in a matched case-control study. Cardiac metastasis was a late event (median 925 days from initial MCC diagnosis). The right heart was predominantly involved (8 of 9; 89%). Among 7 patients treated with immunotherapy, 6 achieved a complete or partial response of the cardiac lesion. Among these 6 responders, 5 received concurrent cardiac radiotherapy (median 20 Gray) with immunotherapy; 4 of 5 did not have local disease progression or recurrence in the treated cardiac lesion. One-year OS was 44%, which was not significantly different from non-cardiac mMCC patients (45%, p = 0.96). Though it occurs relatively late in the disease course, cardiac mMCC responded to immunotherapy and/or radiotherapy and was not associated with worse prognosis compared to mMCC at other anatomic sites. These results are timely as cardiac mMCC may be increasingly encountered in the era of immunotherapy as patients with metastatic MCC live longer.

Higher blood pressure versus normotension targets to prevent acute kidney injury: a systematic review and meta-regression of randomized controlled trials

BackgroundRenal hypoperfusion is one of the most common causes of acute kidney injury (AKI), especially in shock and perioperative patients. An optimal blood pressure (BP) target to prevent AKI remains undetermined. We conducted a systematic review and meta-analysis of available randomized clinical trial (RCT) results to address this knowledge gap.MethodsFrom inception to May 13, 2022, we searched Ovid Medline, EMBASE, Cochrane Library, SCOPUS, clinicaltrials.gov, and WHO ICTRP for RCTs comparing higher BP target versus normotension in hemodynamically unstable patients (shock, post-cardiac arrest, or surgery patients). The outcomes of interest were post-intervention AKI rate and renal replacement therapy (RRT) rate. Two investigators independently screened the citations and reviewed the full texts for eligible studies according to a predefined form.ResultsTwelve trials were included, enrolling a total of 5759 participants, with shock, non-cardiac, and cardiac surgery patients accounting for 3282 (57.0%), 1687 (29.3%) and 790 (13.7%) patients, respectively. Compared to lower mean arterial blood pressure (MAP) targets that served as normotension, targeting higher MAP had no significant effect on AKI rates in shock (RR [95% CI] = 1.10 [0.93, 1.29]), in cardiac-surgery (RR [95% CI] = 0.87 [0.73, 1.03]) and non-cardiac surgery patients (RR [95% CI] = 1.25 [0.98, 1.60]) using random-effects meta-analyses. In shock patients with premorbid hypertension, however, targeting MAP above 70 mmHg resulted in significantly lower RRT risks, RR [95%CI] = 1.20 [1.03, 1.41], p < 0.05.ConclusionsTargeting a higher MAP in shock or perioperative patients may not be superior to normotension, except in shock patients with premorbid hypertension. Further studies are needed to assess the effects of a high MAP target to preventing AKI in hypertensive patients across common settings of hemodynamic instability.Trial registration This systematic review has been registered on PROSPERO (CRD42021286203) on November 19, 2021, prior to data extraction and analysis.

Abstract 15047: Survival With Favorable Neurological Outcome and Quality of CPR Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared to Non-Cardiac Disease

Introduction: Children with cardiac disease have higher rates of in hospital cardiac arrest (IHCA) compared to non-cardiac disease. We aimed to determine differences in survival in children with medical and surgical cardiac compared to non-cardiac disease following IHCA and to assess whether CPR quality was different between groups. Hypothesis: We hypothesized: 1) medical cardiac have worse and surgical cardiac have improved outcomes compared to non-cardiac patients, and 2) CPR quality is similar between groups. Methods: A secondary analysis of the ICU-RESUS citation project ( ICU-RESUS ; NCT02837497) was conducted. The primary outcome was survival to hospital discharge with favorable neurological outcome defined as a Pediatric Cerebral Performance Category score of 1 - 3 or no change from baseline. Secondary outcomes included physiologic measures of intra-arrest quality. Results: Of 1100 children with IHCA, 273 (25%) were medical cardiac, 383 (35%) were surgical cardiac, and 444 (40%) were non-cardiac. The medical cardiac group was less likely to survive with favorable outcome compared to the non-cardiac group (48% vs. 55%, aOR 0.59, CI 95 0.40, 0.88). There was no difference in outcome between the surgical cardiac (58%) and non-cardiac group. There were no differences in chest compression (CC) rate, CC fraction, ventilation rate, intra-arrest average target diastolic blood pressure or average target systolic blood pressure between medical cardiac vs. non-cardiac and surgical cardiac vs. non-cardiac groups. The surgical cardiac group was less likely to achieve target CC depth compared to non-cardiac group (OR 0.15, CI 95 0.02, 0.52). There was no difference in CC depth in medical cardiac vs. non-cardiac groups. Conclusions: In this large study of pediatric IHCA, medical cardiac patients had lower survival with favorable neurologic outcome compared to non-cardiac patients. Surgical cardiac patients had similar outcome to non-cardiac patients. CPR quality was similar in medical-cardiac and non-cardiac patients, however delivered CC depths were lower in surgical cardiac compared to non-cardiac patients.

Abstract 12766: Tropsensor: A Rapid Non-Invasive Transdermal Solution For Troponin Measurement

Introduction: Early identification of Acute Myocardial Injury can prompt rapid triage and appropriate interventions to improve clinical outcomes. Over 10 million patients present at the ED with chest-pain, with the majority due to non-cardiac causes, resulting in unnecessary burdens for Emergency Departments (ED). An instant non-invasive method to measure cardiac troponin (cTn) would therefore be of great benefit. Identified need: All Guidelines recommend the use of high sensitivity (HS) cTn for the diagnosis of acute coronary syndromes (ACS). Current biochemical biomarker testing relies on labeling the cTn with turnaround times often an hour or more. Point-of-care solutions reduce the test time, but still depend on the proper handling of samples and blood processing techniques that could lead to difficulties. Tropsensor provides a non-invasive alternative to standard of care (SOC) hs-cTn measurements without the need for a blood draw. The molecular infrared spectroscopy-based transdermal device provides a cTn readout within 5 minutes and allows for serial measurements without any of the delays or complications of blood draws. Methods: A 26-patient (consented and IRB approved) study was conducted at Zuckerberg San Francisco General Hospital with recruitment based on ACS-related presenting symptoms at the ED. Wrist-worn Tropsensor was used on the patients while the corresponding troponin was determined using a high sensitivity (SOC) assay (Siemens ADVIA Centaur) via a blood draw. Results and conclusions: A Pearson’s correlation of 82% with the hs-cTnI was observed. AMI diagnosis sensitivity was 100%, Specificity=50%, PPV=81.8%, NPV=100% and accuracy=84.6%. The Tropsensor modality seems to provide data similar to that of a hs-cTn assay. If so, it would accelerate the assessment of patients presenting with chest pain. By not requiring a blood draw, the Tropsensor could provide a rapid, safe, standardized and reliable source for cTn while allowing bedside serial trending. It thus has the potential to streamline cardiac care workflow by ruling-out many non-cardiac patients and identifying those with high values who are at risk. Such an approach has the potential to facilitate appropriate patient triage towards early discharge of emergent treatment.

Rise CKMB and Myoglobin Levels in Non-Cardiac Patients of Ischemic Stroke Presenting to Emergency Department of a Tertiary Care Hospital

Objective: To assess the rise in CKMB and Myoglobin levels and associated factors in non-cardiac patients of ischemic stroke presenting to the Emergency Department of a Tertiary Care Hospital.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Emergency Medicine, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Dec 2020 to May 2021.&#x0D; Methodology: A total of 150 patients with ischemic stroke diagnosed by the consultant Emergency physician or medical specialist based on clinical and neuro-radiological findings were included in this study. Serum CKMB and myoglobin levels were assessed along with other baseline investigations among the study participants. In addition, the relationship of age, gender, the severity of the stroke and the presence of non-cardiac comorbidities was assessed with the rise in CKMB and myoglobin levels among the target population.&#x0D; Results: Out of 200 patients with ischemic stroke included in the study, 114(67.0%) were males, while 86(43.0%) were females. 75(37.5%) patients had either raised CKMB or Myoglobin levels, while 125(62.5%) patients had both biomarkers within range. On the National Institutes of Health Stroke Scale, 110(55.0%) patients had mild, 55(22.5%) had mild to moderately severe, 25(12.5%) had severe, and 10(5.0%) had very severe symptoms. Statistical analysis revealed that increased stroke severity had a statistically significant relationship (p-value&lt;0.001) with raised CKMB/Myoglobin levels in the target population.&#x0D; Conclusion: Raised CKMB or myoglobin levels were found in many patients with acute ischemic stroke. The stroke severity was associated with raised levels of these biomarkers.

Risk Factors of Coronary Artery Disease: A Hospital-Based Study.

Coronary artery disease is among the leading cause of morbidity and mortality worldwide. There are limited scientific evidence on the risk factors for coronary artery disease specific to the Nepalese context. This study aimed to determine the association of various modifiable cardiovascular risk factors with coronary artery disease in Nepal. It is a hospital-based case-control study conducted among 300 participants. Case group comprised of 150 newly diagnosed coronary artery disease patients attending Manmohan Cardiothoracic Vascular and Transplant Centre while the Age and sex matched non-cardiac patients (n=150) from the outpatient department of the Department of General Practice and Emergency Medicine of Tribhuvan University Teaching Hospital were recruited as controls. Adjusted odds ratios (AOR) were calculated using multivariable logistic regression. Of the 300 participants, 208 (69.3%) were males and 92 (30.7%) were females. The mean age was 59.8 years ± 11 years (standard deviation). In multivariable analysis, current smoking (AOR=3.05, 95% CI: 1.61-5.78), hypertension (AOR=1.82, 95% CI: 1.08-3.09), diabetes (AOR=3.78, 95% CI: 1.91-7.47), family history of coronary artery disease (AOR=2.92, 95% CI: 1.27-6.71), and low high density lipoprotein (AOR= 2.0, 95% CI: 1.17-3.42) were significantly associated with coronary artery disease. Current alcohol use (AOR=0.51, 95% CI: 0.29-0.89) was identified as a protective factor for coronary artery disease. Among the modifiable cardiovascular risk factors, smoking, hypertension, diabetes, and low level of high density lipoprotein were significantly associated with coronary artery disease, which should be considered while developing public health interventions for cardiovascular disease prevention in Nepal in future.

Quantitation of cardiac troponin I in cancer patients treated with immune checkpoint inhibitors: a case-control study.

Immune checkpoint inhibitors (ICIs) cause a variety of toxicities, including immune-related adverse events (irAEs), but there are no biomarkers to predict theirdevelopment. Guidelines recommend measuring circulating cardiac troponin I (cTnI) during ICI therapy to detect related cardiotoxicities. Moreover, elevated cTnI has also been associated with worse outcomes in non-cardiac patients, including cancer. Thus here, we investigated whether cTnI levels were higher in patients with irAEs. The study consisted of three groups; 21 cancer patients undergoing ICI immunotherapies who presented with irAEs, four patients without irAEs, and 20 healthy controls. Patient samples were assessed at baseline (n=25), during ICI treatment (n=25, median=6weeks of treatment) and at toxicity (n=6, median=13weeks of treatment). Inaddition to blood high sensitivity cardiac troponin I (hs-cTnI), anti-thyroglobulin (TG) andanti-thyroid peroxidase (TPO) antibodies were also quantitated to detect thyroid dysfunction, constituting the second leading toxicity (23.8%) after pneumonitis (28.6%). Four patients with irAEs (n=4/21; 19%) and one without irAEs (n=1/4; 25%) showed higher hs-cTnI levels at any time-point; the remaining had physiological levels. None of these patients developed cardiotoxicity. Concurrent elevated levels of anti-thyroid antibodies and hs-cTnI were detected in one patient with thyroid dysfunction (n=1/5, 20%). However, these antibodies were also elevated in three patients (n=3/16, 19%) with non-thyroid irAEs and in up to 40% of healthy controls. hs-cTnI was not elevated in patients with irAEs, but larger studies are needed to confirm these observations.

Factors Associated with Survival after Extracorporeal Cardiopulmonary Resuscitation in Noncardiac Pediatric Patients

Factors Associated with Survival after Extracorporeal Cardiopulmonary Resuscitation in Noncardiac Pediatric Patients

Vancomycin dosing required to achieve a therapeutic level in children post-surgical correction of congenital heart disease.

The vancomycin dosing range for safe and effective treatment remains uncertain for children who had corrective surgery for a congenital heart disease (CHD). We aimed to determine the vancomycin dosing requirements for this subgroup of patients.This prospective cohort study included children younger than 14 years old with CHD who received intravenous vancomycin for at least 3 days at the Pediatric Cardiology section of King Abdulaziz Medical City, Riyadh.In total, 140 pediatric patients with CHD were included with a median age of 0.57 years (interquartile range 0.21–2.2). The mean vancomycin total daily dose (TDD), 37.71 ± 6.8 mg/kg/day, was required to achieve a therapeutic trough concentration of 7–20 mg/L. The patient’s age group and the care setting were significant predictors of the vancomycin dosing needs. Neonates required significantly lower doses of 34 ± 6.03 mg/kg/day (P = .002), and young children higher doses of 43.97 ± 9.4 mg/kg/day (P = .003). The dosage requirements were independent of the type of cardiac lesion, cardiopulmonary surgery exposure, sex, and BMI percentile. However, the patients in the pediatric cardiac ward required higher doses of vancomycin 41.08 ± 7.06 mg/kg/day (P = .039). After the treatment, 11 (8.5%) patients had an elevated Scr, and 3 (2.3%) patients developed AKI; however, none of the patients’ sociodemographic factors or clinical variables, or vancomycin therapy characteristics was significantly associated with the renal dysfunction.Overall, the vancomycin TDD requirements are lower in pediatric post-cardiac surgery compared to non-cardiac patients and are modulated by several factors.

Prevalence of cardiac amyloidosis among cardiac- and non-cardiac patients undergoing echocardiography at a large university echo lab in Germany: a cohort study

Abstract Background Cardiac amyloidosis (CA) is a progressive infiltrative cardiomyopathy that leads to severe heart failure and, once clinically relevant, poses a high mortality risk. Epidemiological data for CA are still sparse and heterogeneous, but urgently needed since novel therapies against ATTR-CA are now available. Aim We aimed to assess minimum prevalence rates of CA among cardiac and non-cardiac patients undergoing routine echocardiography in an echo lab of a large university clinic serving all medical specialities in central Germany. Methods We established a retro- and prospective database based on suspicious findings in echocardiography for all echocardiographic exams over an 8.5 year period (03/2013 and 09/2021). During this time, 41,375 patients underwent at least one echo exam. Indication for echos were mixed, and consisted of non-cardiac and cardiac patients with acute and chronic illnesses as well as screening exams (e.g. before major surgery or chemotherapy). Suspicious echocardiography were retrospectively analysed whether they underwent further diagnostic or if it remained an unproven suspicion (figure). All echos of suspicious cases were comprehensively re-analysed regarding novel surrogate parameters and indices for CA. Various clinical and laboratory parameters were collected. Results The mean age of the cohort of 41,375 patients was 65.1±15.8 years for the first or only echo examination with a slightly unbalanced gender distribution (45% female). The age distribution is shown in the table. While 128 patients were suspected, the diagnosis was falsified in 16 patients and proven in 47 patients (light chain n=16, ATTR n=31; figure). A substantial proportion of patients with suspicious echo received no further diagnostic work-up (N=65). Over the given time frame of 101 months, the prevalence of suspicious echocardiograms was 1 per 323 patients (or 31 per 10,000). The proven cases had a prevalence of 1 per 880 patients (or 11.3 per 10,000). Since ATTR-CA is a disease of the elderly, we saw a vanishingly small number of cases in persons younger than 70 years (table), whereas 90% of all CA patients were older than 70 years. At timing of diagnosis, AL-CA patients were almost 10 years younger compared to diagnosis of ATTR-CA (69.1±8.4 years vs. 77.4±8.5 years). In patients older than 80 years, the prevalence rate of ATTR-CA peaked with 22.6 cases per 10.000 patients (0.23%). The prevalence rate of ATTR-CA was roughly twice as high compared to AL-CA. Conclusion For the first time, an estimation of minimum prevalence rates for CA for a defined volume of echocardiograms in an all-comers population is provided. In a mixed population of a hospital of maximum care CA prevalence rate is much higher than expected. Awareness for this “rare” disease is needed, since routine echo exams can prompt suspicion in clinically silent or so far unrecognized CA cases. Funding Acknowledgement Type of funding sources: None.

Perioperative myocardial injury after non-cardiac surgery: long-term mortality according to cardiovascular risk

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 &amp;lt;60 ml/min, or presence of, at least, 3 risk factors (hypertension, smoking, dyslipidemia, or age &amp;gt;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&amp;lt;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.

Clinical agreement of a novel algorithm to estimate radial artery blood pressure from the non-invasive finger blood pressure

Study objectiveA new algorithm was developed that transforms the non-invasive finger blood pressure (BP) into a radial artery BP (B̂PRad), whereas the original algorithm estimated brachial BP (B̂PBra). In this study we determined whether this new algorithm shows better agreement with invasive radial BP than the original one and whether in the operating room this algorithm can be used safely. Design, setting and patientsThis observational study was conducted on thirty-three non-cardiac surgery patients. Intervention and measurementsInvasive radial and non-invasive finger BP were measured, of the latter B̂PRad and B̂PBra were transformed. Agreement of systolic, mean, and diastolic arterial BP (SAP, MAP, and DAP, respectively) was assessed traditionally with Bland-Altman and trend analysis and clinically safety was quantified with error grid analyses. A bias (precision) of 5 (8) mmHg or less was considered adequate. Main resultsThirty-three patients were included with an average of 676 (314) 20 s segments. For both comparisons, bias (precision) of MAP was within specified criteria, whereas for SAP, precision was higher than 8 mmHg. B̂PRad showed a better agreement than B̂PBra with BPRad for DAP values (bias (precision): 0.7 (6.0) and − 6.4 (4.3) mmHg, respectively). B̂PRad and B̂PBra both showed good concordance in following changes in BPRad (for all parameters overall degree was <7°). There were slightly more measurement pairs of MAP within the no-risk zone for B̂PRad than for B̂PBra (96 vs 77%, respectively). ConclusionsIn this cohort of non-cardiac surgery patients, we found good agreement between BPRad and B̂PRad. Compared to B̂PBra, B̂PRad shows better agreement although clinical implications are small.This trial was registered with ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03795831).