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Journal of Clinical Monitoring and Computing

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Open Access 24-02-2022 | Abdominal Surgery | Original Research

Effect of intraoperative personalized goal-directed hemodynamic management on acute myocardial injury in high-risk patients having major abdominal surgery: a post-hoc secondary analysis of a randomized clinical trial

Authors: Karim Kouz, Alina Bergholz, Oliver Diener, Maximilian Leistenschneider, Christina Thompson, Friederike Pichotka, Constantin Trepte, Edzard Schwedhelm, Thomas Renné, Linda Krause, Julia Y. Nicklas, Bernd Saugel

Published in: Journal of Clinical Monitoring and Computing | Issue 6/2022

Abstract

Acute myocardial injury is common after noncardiac surgery and associated with mortality. Impaired intraoperative cardiovascular dynamics are a risk factor for acute myocardial injury. Optimizing intraoperative cardiovascular dynamics may thus reduce acute myocardial injury. We aimed to investigate the effect of intraoperative personalized goal-directed hemodynamic management on the incidence of acute myocardial injury. We hypothesized that personalized goal-directed hemodynamic management reduces the incidence of acute myocardial injury compared to routine hemodynamic management in high-risk patients having major abdominal surgery. We performed a post-hoc secondary analysis of a randomized clinical trial including 180 high-risk major abdominal surgery patients that were randomized to personalized goal-directed hemodynamic management or routine hemodynamic management. We compared the incidences of acute myocardial injury—defined according to the Fourth Universal Definition of Myocardial Infarction (2018)—between patients randomized to personalized goal-directed hemodynamic management or routine hemodynamic management by calculating the relative and absolute risk reduction together with 95% Wald confidence intervals and P values. Acute myocardial injury occurred in 4 of 90 patients (4%) in the personalized goal-directed hemodynamic management group and in 12 of 90 patients (13%) in the routine hemodynamic management group (relative risk: 0.33, 95% confidence interval: 0.11 to 0.99, P = 0.036; absolute risk reduction: − 9%, 95% confidence interval: − 17% to − 0.68%, P = 0.034). In this post-hoc secondary analysis, intraoperative personalized goal-directed hemodynamic management reduced the incidence of acute myocardial injury compared to routine hemodynamic management in high-risk patients having major abdominal surgery. This needs to be confirmed in larger prospective trials.

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Title: Effect of intraoperative personalized goal-directed hemodynamic management on acute myocardial injury in high-risk patients having major abdominal surgery: a post-hoc secondary analysis of a randomized clinical trial
Authors: Karim Kouz
Alina Bergholz
Oliver Diener
Maximilian Leistenschneider
Christina Thompson
Friederike Pichotka
Constantin Trepte
Edzard Schwedhelm
Thomas Renné
Linda Krause
Julia Y. Nicklas
Bernd Saugel
Publication date: 24-02-2022
Publisher: Springer Netherlands
Keyword: Abdominal Surgery
Published in: Journal of Clinical Monitoring and Computing / Issue 6/2022
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-022-00826-0

At a glance: The STEP trials

Springer Medicine

Effect of intraoperative personalized goal-directed hemodynamic management on acute myocardial injury in high-risk patients having major abdominal surgery: a post-hoc secondary analysis of a randomized clinical trial

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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