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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

February 24, 2022

Abstract
Acute myocardial injury is common after noncardiac surgery and associated with mortality. Impaired intraoperative cardio- vascular 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 manage- ment 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.
Keywords Cardiac output · Cardiovascular dynamics · Goal-directed therapy · Hemodynamic monitoring · Myocardial injury after noncardiac surgery · Randomized trial