Strike a POISE
These were the objectives and primary endpoints of of POISE 1, published in 2008.
What is investigating the effects of perioperative beta blockers (metoprolol) for the primary end points of cardiovascular death, non-fatal myocardial infarction, and non-fatal cardiac arrest?
In 2011, Rodseth and colleagues published that these biomarkers may be measured preoperatively to supplement cardiac risk assessment in appropriate high-risk patients.
What are BNP or NT-proBNP?
This is the gold standard for objective functional capacity assessment.
What is cardiopulmonary exercise testing (CPET)
This is what POISE 3 investigated with regards to TXA
What is effect of TXA on critical bleeding and on venous/arterial thrombosis
This was how many patients were included in VISION trials
How many is 40,004 patients?
This was the clinical result of POISE 1 (perioperative metoprolol vs placebo for incidence of myocardial infarction)
What trial had fewer patients in metoprolol group with myocardial infarction, but had more deaths, and higher incidence of stroke?
This is the diagnostic criteria for MINS.
What is an ischemic troponin elevation within 30 days after non-cardiac surgery, without need of ischaemic features?
A structured tool that can be used to evluate a patient's functional status
What is the Duke Activity Status Index (DASI)
The long version of POISE acronym
What is PeriOperative ISchemic Evaluation?
This was how many times the observed event rate of major vascular events exceeded the expected event rate predicted by the Revised Cardiac Risk Index (RCRI) in the VISION RCRI study
What is 6 times! The observed event rate of major vascular events was increased 6-fold compared with the event rate expected from the RCRI
The POISE 1 trial, published in 2008, highlighted the importance of this concept for perioperative research.
What study highlighted the risk in assuming a practice (perioperative beta-blocker regimen) has benefit without substantial harm, and it stressed the importance and need for large randomised trials in the perioperative setting?
The pathophysiologic mechanism causing approximately 70% of MINS
What is 'supply-demand mismatch' (69-77% )?
Thrombosis causes 23–31%
almost all have CAD
The DASI score which can identify patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability
What is DASI Score = 34
This is what POISE 3 investigated with regards to perioperative hyper and hypotension
What is effect of perioperative hypotension and hypertension on major CV events
This is the relationship between post-operative troponin values and vascular death and MACE
Higher peak troponin was correlated with greater 30 day mortality
Patients with a peak TnT value of 0.01 ng/mL or less, 0.02, 0.03-
0.29, and 0.30 or greater had 30-day mortality rates of 1.0%, 4.0%, 9.3%, and 16.9%,
respectively.
In POISE 2 (which compared post-operative aspirin to placebo), this was the difference in death or non fatal myocardial infarction at 30 days
What is no significant difference in rate of death or non-fatal MI?
*however, there was increased risk of bleeding in aspirin group
The 6 risk factors included in the Lee Criteria (Revised Cardiac Risk Index)
What are:
1. History of ischemic heart disease
2. High risk surgery
3. History of congestive heart failure
4. History of cerebrovascular disease
5. Preoperative treatment with insulin
6. Preoperative serum creatinine >2 mg/dL / 176.8 µmol/L
Climbing two flights of stairs is approximately equivalent to this number of METs.
What is 4 METs
This was a finding of a sub-study of POISE 2 - which investigated perioperative clonidine use for patients undergoing non-cardiac surgery.
The primary outcome was composite of death and non fatal myocardial infarction at 30 days
What is low-dose clonidine did not reduce the outcome of death or nonfatal myocardial infarction?
it did, however, increase the risk of clinically important hypotension and nonfatal cardiac arrest.
In the VISION RCRI cohort this propotion of MIs (%) occurred without ischemic symptoms and were only detected with troponin monitoring
What is 66.7% ?
12 / 18 patients who had MI had no ischemic symptoms to suggest myocardial infarction.
One conclusion of study was that monitoring troponins after surgery can assist physicians to avoid missing MI
This was a finding of a sub-study of POISE 2 which investigated perioperative aspirin for patients with prior PCI
In patients with prior PCI, aspirin reduced the risk for death and non-fatal myocardial infarction
In 2014, Rodseth and colleagues published that checking this lab value post-operatively can enhance risk stratification for perioperative cardiovascular complications
What is a post-operative B-type natriuretic peptide level?
This is how accurate anesthesiologists are at subjective assessment of patient's inability to achieve 4 METS
What is terrible? Subjective assessment had 19·2% sensitivity and 94·7% specificity for identifying the inability to attain four metabolic equivalents during CPET
Results of POISE 3 comparing hypertension-avoidance to hypotension avoidance on 30 day major CV event
What is no difference ?
The VISION-MINS study identified that elevated troponin after non cardiac surgery independently predicted this
What is 30 day mortality?