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Original research article
Daytime variation of perioperative myocardial injury in non-cardiac surgery and effect on outcome
  1. Jeanne du Fay de Lavallaz1,2,
  2. Christian Puelacher1,2,
  3. Giovanna Lurati Buse3,
  4. Daniel Bolliger4,
  5. Dominic Germanier1,2,
  6. Reka Hidvegi1,2,4,
  7. Joan Elias Walter1,2,
  8. Raphael Twerenbold1,
  9. Ivo Strebel1,
  10. Patrick Badertscher1,
  11. Lorraine Sazgary1,2,
  12. Andreas Lampart4,
  13. Jaqueline Espinola5,
  14. Christoph Kindler5,
  15. Angelika Hammerer-Lercher6,
  16. Saranya Thambipillai1,
  17. Lorenz Guerke7,
  18. Katharina Rentsch8,
  19. Andreas Buser9,10,
  20. Danielle Gualandro1,11,
  21. Marcel Jakob12,
  22. Christian Mueller1
  23. for the BASEL-PMI Investigators
    1. 1 Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Basel, Switzerland
    2. 2 Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
    3. 3 Department of Anaesthesia, University Hospital Düsseldorf, Düsseldorf, Germany
    4. 4 Department of Anaesthesia, University Hospital Basel, Basel, Switzerland
    5. 5 Kantonsspital Aarau, Department of Anaesthesia, Aarau, Switzerland
    6. 6 Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
    7. 7 Department of Vascular Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
    8. 8 Department of Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
    9. 9 Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
    10. 10 Department of Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
    11. 11 Department of Cardiology, Instituto di Coração, University of São Paulo, Sao Paulo, Brazil
    12. 12 Department of Traumatology and Orthopedics, University Hospital Basel, University of Basel, Basel, Switzerland
    1. Correspondence to Professor Christian Mueller, Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, Basel 4031, Switzerland; Christian.Mueller{at}usb.ch

    Abstract

    Objective Recently, daytime variation in perioperative myocardial injury (PMI) has been observed in patients undergoing cardiac surgery. We aim at investigating whether daytime variation also occurs in patients undergoing non-cardiac surgery.

    Methods In a prospective diagnostic study, we evaluated the presence of daytime variation in PMI in patients at increased cardiovascular risk undergoing non-cardiac surgery, as well as its possible impact on the incidence of acute myocardial infarction (AMI), and death during 1-year follow-up in a propensity score–matched cohort. PMI was defined as an absolute increase in high-sensitivity cardiac troponin T (hs-cTnT) concentration of ≥14 ng/L from preoperative to postoperative measurements.

    Results Of 1641 patients, propensity score matching defined 630 with similar baseline characteristics, half undergoing non-cardiac surgery in the morning (starting from 8:00 to 11:00) and half in the afternoon (starting from 14:00 to 17:00). There was no difference in PMI incidence between both groups (morning: 50, 15.8% (95% CI 12.3 to 20.3); afternoon: 52, 16.4% (95% CI 12.7 to 20.9), p=0.94), nor if analysing hs-cTnT release as a quantitative variable (median morning group: 3 ng/L (95% CI 1 to 7 ng/L); median afternoon group: 2 ng/L (95% CI 0 to 7 ng/L; p=0.16). During 1-year follow-up, the incidence of AMI was 1.2% (95% CI 0.4% to 3.2%) among morning surgeries versus 4.1% (95% CI 2.3% to 6.9%) among the afternoon surgeries (corrected HR for afternoon surgery 3.44, bootstrapped 95% CI 1.33 to 10.49, p log-rank=0.03), whereas no difference in mortality emerged (p=0.70).

    Conclusions Although there is no daytime variation in PMI in patients undergoing non-cardiac surgery, the incidence of AMI during follow-up is increased in afternoon surgeries and requires further study.

    Clinical trial registration NCT02573532;Results.

    • acute myocardial infarction
    • coronary artery disease
    • acute coronary syndromes
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    Footnotes

    • JdFdL and CP contributed equally.

    • Contributors All the authors are justifiably credited with authorship according to the authorship criteria. JdFL, CP, GLB, DB, AL, CK, AH-L, LG, DMG, MJ, CM: conception, design. DG, RH, LS, JE, ST: acquisition of data. JdFL, CP, JEW, RT, IS, PB: analysis and interpretation of data. JdFL, CP, CM: drafting of the manuscript and final approval. KR, AB: coordination of laboratory measurements.

    • Funding This study was funded by the University Basel, the University Hospital Basel, the Swiss Heart Foundation, Abbott, Astra Zeneca, the PhD Educational Platform for Health Sciences, the Forschungsfond Kantonsspital Aarau and the Cardiovascular Research Foundation Basel.

    • Competing interests CP reports grants from PhD Educational Platform for Health Sciences and the University Hospital Basel during the conduct of the study. GLB reports grants from University of Basel during the conduct of the study. RT reports research support from the Swiss National Science Foundation (grant no. P300PB 167803), the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, the University of Basel and the University Hospital Basel; and speaker honoraria/consulting honoraria from Roche, Abbott, Siemens, Singulex and ThermoScientific BRAHMS. CM reports grants from the Swiss Heart Foundation and grants and non-financial support from several diagnostic companies during the conduct of the study, as well as grants, personal fees and non-financial support from several diagnostic companies outside the submitted work.

    • Patient consent Obtained.

    • Ethics approval Ethics committee Nordwestschweiz.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators Claudia Huck, Michael Freese, Kathrin Meissner, Thomas Nestelberger, Desiree Wussler, Jasper Boeddinghaus, Nikola Kozhuharov, Christoph Kaiser, Gregor Fahrni, Stefan Osswald: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel; Luzius Steiner, Manfred Seeberger: Department of Anaesthesia, University Hospital Basel, Switzerland; Riham Mafouz: Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, and Menofiya University, Medical School, Egypt.

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