Research article

The incidence of myocardial injury following post-operative Goal Directed Therapy

Rupert M Pearse^1,3 , Deborah Dawson² , Jayne Fawcett² , Andrew Rhodes² , R Michael Grounds² and David Bennett²

¹Barts and The London School of Medicine and Dentistry, Queen Mary's University of London, UK

²Intensive Care Unit, St. George's Hospital, London, UK

³Anaesthetic Laboratory, 5th floor, 38 Little Britain, St. Bartholomew's Hospital, London. EC1A 7BE, UK

author email corresponding author email

BMC Cardiovascular Disorders 2007, 7:10doi:10.1186/1471-2261-7-10

Published:	19 March 2007

Abstract

Background

Studies suggest that Goal Directed Therapy (GDT) results in improved outcome following major surgery. However, there is concern that pre-emptive use of inotropic therapy may lead to an increased incidence of myocardial ischaemia and infarction.

Methods

Post hoc analysis of data collected prospectively during a randomised controlled trial of the effects of post-operative GDT in high-risk general surgical patients. Serum troponin T concentrations were measured at baseline and on day 1 and day 2 following surgery. Continuous ECG monitoring was performed during the eight hour intervention period. Patients were followed up for predefined cardiac complications. A univariate analysis was performed to identify any associations between potential risk factors for myocardial injury and elevated troponin T concentrations.

Results

GDT was associated with fewer complications, and a reduced duration of hospital stay. Troponin T concentrations above 0.01 μg l^-1 were identified in eight patients in the GDT group and six in the control group. Values increased above 0.05 μg l^-1 in four patients in the GDT group and two patients in the control group. There were no overall differences in the incidence of elevated troponin T concentrations. The incidence of cardiovascular complications was also similar. None of the patients, in whom troponin T concentrations were elevated, developed ECG changes indicating myocardial ischaemia during the intervention period. The only factor to be associated with elevated troponin T concentrations following surgery was end-stage renal failure.

Conclusion

The use of post-operative GDT does not result in an increased incidence of myocardial injury.