Abstract
Background
Myocardial injury after noncardiac surgery (MINS) carries a high postoperative mortality.
In this preplanned, subgroup analysis of the randomized DEX-2-TKA Trial, we investigated
the effect of dexamethasone versus placebo on the concentration of cardiac troponin
I and T (TnI and TnT) on the first postoperative morning after total knee arthroplasty.
In addition, frequency of MINS, myocardial infarction, and major adverse cardiovascular
events where evaluated.
Methods
We included 290 patients who received either 24 mg of dexamethasone intravenously
(given perioperatively) or placebo. Blood samples were analyzed as either TnI or T
depending on trial site.
Results
A total of 236 samples were eligible for analysis of TnI and 38 samples for TnT on
the first postoperative morning. The median (IQR) TnI concentration was 4.6 ng/L (0-7.2
ng/L) in the dexamethasone group and 4.5ng/l (0-7.0 ng/L) in the placebo group (P = .96) on the first postoperative morning. The median TnT was 9 ng/L (6-11 ng/L)
in the dexamethasone group and 8 ng/L (5-10 ng/L) in the placebo group (P = .68). The frequencies of MINS, myocardial infarction, and major adverse cardiovascular
events were similar in the compared groups, but these analyses were underpowered.
Conclusion
We found no effect of dexamethasone on postoperative concentration of troponin I or
T on the first postoperative morning after total knee arthroplasty.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Troponin T as a marker for myocardial ischemia in patients undergoing major noncardiac surgery.Am J Cardiol. 1996; 77: 1031-1036https://doi.org/10.1016/S0002-9149(96)00126-9
- Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery.Am Heart J. 2018; 203: 67-73https://doi.org/10.1016/j.ahj.2018.06.012
- Myocardial injury after non-cardiac surgery: A perioperative affair?.Minerva Anestesiol. 2018; 84: 1209-1218https://doi.org/10.23736/s0375-9393.18.12537-5
- Predicting myocardial injury and other cardiac complications after elective noncardiac surgery with the revised cardiac risk index: the VISION Study.Can J Cardiol. 2021; 37: 1215-1224https://doi.org/10.1016/j.cjca.2021.03.015
- Association between postoperative troponin troponin levels and 30-day mortality among patients undergoing noncardiac surgery.J Am Med Assoc. 2012; 307: 2295-2304
- Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis.Br J Anaesth. 2016; 117: 559-568https://doi.org/10.1093/bja/aew321
- Myocardial injury after noncardiac surgery - an update.Curr Opin Anaesthesiol. 2021; 34: 381-386https://doi.org/10.1097/ACO.0000000000000981
- Cardiac troponin T and troponin I in the general population: comparing and contrasting their genetic determinants and associations with outcomes.Circulation. 2019; 139: 2754-2764https://doi.org/10.1161/CIRCULATIONAHA.118.038529
- High-sensitivity cardiac troponin I is a strong predictor of cardiovascular events and mortality in the AGES-Reykjavik community-based cohort of older individuals.Clin Chem. 2016; 62: 623-630https://doi.org/10.1373/clinchem.2015.250811
- Prognostic value of changes in high-sensitivity cardiac troponin T beyond biological variation in stable outpatients with cardiovascular disease: a validation study.Clin Res Cardiol. 2022; 111: 333-342https://doi.org/10.1007/s00392-021-01952-6
- Myocardial injury after noncardiac surgery.Curr Opin Cardiol. 2014; 29: 307-311https://doi.org/10.1097/HCO.0000000000000069
- Cardiac complications in patients undergoing major noncardiac surgery.N Engl J Med. 2015; 373: 2258-2269https://doi.org/10.1056/NEJMra1502824
- Association of perioperative myocardial injury with 30-day and long-term mortality in older adult patients undergoing orthopedic surgery in China.Med Sci Monit. 2021; 27: 1-11https://doi.org/10.12659/MSM.932036
- High-sensitivity troponin I after cardiac surgery and 30-day mortality.N Engl J Med. 2022; 386: 827-836https://doi.org/10.1056/nejmoa2000803
- Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial.Lancet. 2018; 391: 2325-2334https://doi.org/10.1016/S0140-6736(18)30832-8
- The effect of remote ischaemic preconditioning on myocardial injury in emergency hip fracture surgery (PIXIE trial): phase II randomised clinical trial.BMJ. 2019; 367: I6395https://doi.org/10.1136/bmj.l6395
- Effect of intraoperative dexamethasone on major complications and mortality among infants undergoing cardiac surgery: the DECISION randomized clinical trial.JAMA. 2020; 323: 2485-2492https://doi.org/10.1001/jama.2020.8133
- Effect of dexamethasone on complications or all cause mortality after major non-cardiac surgery: multicentre, double blind, randomised controlled trial.BMJ. 2021; 373: 1-12https://doi.org/10.1136/bmj.n1162
- Role of lipocortin-1 in the anti-hyperalgesic actions of dexamethasone.Br J Pharmacol. 1997; 121: 883-888https://doi.org/10.1038/sj.bjp.0701211
- Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial.Br J Anaesth. 2011; 106: 230-238https://doi.org/10.1093/bja/aeq333
- Preferential inhibition of adaptive immune system dynamics by glucocorticoids in patients after acute surgical trauma.Nat Commun. 2020; 11: 1-12https://doi.org/10.1038/s41467-020-17565-y
Meng J, Li L. The efficiency and safety of dexamethasone for pain control in total joint arthroplasty. Medicine (Baltimore). 2017;96(24):e7126. https://doi.org/10.1097/md.0000000000007126.
- Preoperative methylprednisolone enhances recovery after endovascular aortic repair: A randomized, double-blind, placebo-controlled clinical trial.Ann Surg. 2014; 260: 540-549https://doi.org/10.1097/SLA.0000000000000895
- Perioperative systemic steroid for rapid recovery in total knee and hip arthroplasty: a systematic review and meta-analysis of randomized trials.J Orthop Surg Res. 2017; 12: 100https://doi.org/10.1186/s13018-017-0601-4
- Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial.BMJ. 2022; 376: 1-11https://doi.org/10.1136/bmj-2021-067325
- Therapeutic manipulation of glucocorticoid metabolism in cardiovascular disease.Br J Pharmacol. 2009; 156: 689-712https://doi.org/10.1111/j.1476-5381.2008.00047.x
- Diagnosis and management of patients with myocardial injury after noncardiac surgery: a scientific statement from the American Heart Association.Circulation. 2021; 144: e287-e305https://doi.org/10.1161/CIR.0000000000001024
- DEX-2-TKA—DEXamethasone twice for pain treatment after total knee arthroplasty: a protocol for a randomized, blinded, three-group multicentre clinical trial.Acta Anaesthesiol Scand. 2020; 64: 267-275https://doi.org/10.1111/aas.13481
- DEX-2-TKA - DEXamethasone twice for pain treatment after total knee arthroplasty: detailed statistical analysis plan for a randomized, blinded, three-group multicentre clinical trial.Acta Anaesthesiol Scand. 2020; 64: 839-846https://doi.org/10.1111/aas.13560
- Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery.JAMA. 2017; 317: 1642-1651https://doi.org/10.1001/jama.2017.4360
- Canadian Cardiovascular Society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery.Can J Cardiol. 2017; 33: 17-32https://doi.org/10.1016/j.cjca.2016.09.008
- Dexamethasone induces transcriptional activation of Bcl-xL gene and inhibits cardiac injury by myocardial ischemia.Eur J Pharmacol. 2011; 668: 194-200https://doi.org/10.1016/j.ejphar.2011.06.019
- The glucocorticoid receptor in cardiovascular health and disease.Cells. 2019; 8: 1-21https://doi.org/10.3390/cells8101227
- Perioperative inflammation and its modulation by anesthetics.Anesth Analg. 2018; 126: 1058-1067https://doi.org/10.1213/ANE.0000000000002484
- Anesthesia-induced immune modulation.Curr Opin Anaesthesiol. 2019; 32: 799-805https://doi.org/10.1097/ACO.0000000000000790
Article info
Publication history
Published online: October 14, 2022
Footnotes
Funding: Analyses were funded by a grant from the Næstved, Slagelse, and Ringsted (NSR) Hospitals Research Fund and the Departments of Anesthesiology at NSR Hospitals and Bispebjerg Hospital.
Conflicts of Interest: AKM, KSG, THL, JCJ, IG, OM, and DH-P report none. CSM reports being a cofounder of a start-up company, WARD247 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD-project (wireless assessment of vital signs). WARD247 ApS has finalized terms for license agreement for any WARD-project software and patents. One patent has been filed: “Wireless Assessment of Respiratory and circulatory Distress (WARD) – Clinical Support System (CSS) – an automated clinical support system to improve patient safety and outcomes” and also reports direct and indirect research funding from Merck Sharp & Dohme Corp., Radiometer and Boehringer Ingelheim, as well as lecture fees from Radiometer, all outside the submitted work.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
