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英文摘要
 DESCRIPTION (provided by applicant): Major adverse cardiac events, such as myocardial infarction (MI), after non-cardiac surgery kill more Americans each year than all motor vehicle deaths combined. Perioperative ß-blocker therapy is the only evidence-based intervention that has been shown to reduce perioperative cardiac risk. Unfortunately, when practiced as usual (i.e., as "preoperative ß-blocker therapy", starting an oral ß-blocker before surgery and continuing throughout the perioperative period), perioperative ß-blockade is associated with harm. It exposes all patients to strong ß-blockade regardless of the hemodynamic status. When patients on ß-blockers develop hypovolemia, they are unable to maintain cardiac output, and are at risk for prolonged hypotension, shock, stroke and death. This proposal will test a novel strategy that will retain the effective protection of ß-blockers against perioperative myocardial ischemia, yet not increase overall risk. Specifically, the objective of this application is to determine if postoperative ß-blocker therapy (rather than preoperative) is a safe and effective regimen to reduce perioperative cardiac risk. Specific aim 1 will test the hypothesis that a titrated postoperative metoprolol regimen (IV followed by oral) will significantly reduce myocardial injury and ischemia in high-risk patients undergoing major non-cardiac surgery, without increasing the risk of hypotension. Using high-sensitivity cardiac troponin (hs-cTn) as marker for myocardial injury and continuous 12-lead Holter ECG for myocardial ischemia, the hypothesis will be tested in a well-powered single-center randomized controlled trial (n=600). Primary efficacy endpoints are myocardial ischemia and injury. Primary safety endpoint is clinically relevant hypotension. Recently, hs-cTn has been shown to strongly predict perioperative major adverse cardiac events and death after non-cardiac surgery. Specific aim 2 will extend this concept and test the hypothesis that preoperative hs-cTn concentration can identify patients who may benefit from postoperative ß-blocker therapy. This hypothesis will be tested within the same trial cohort. This research is both significant and innovative as it studies an important public health problem and offers a novel potential option to the vexing problem of perioperative ß-blocker therapy.
期刊论文(11)
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会议论文
Functional status assessment for preoperative cardiac risk prediction.
术前心脏风险预测的功能状态评估。
DOI: 10.1097/aia.0000000000000305
发表时间: 2021
期刊: International anesthesiology clinics
影响因子: 0.6
作者: [Rubin,DanielS]
通讯作者: Rubin,DanielS
High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery.
接受非心脏手术的年轻健康成年人的高敏心肌肌钙蛋白 T。
DOI: 10.1016/j.bja.2017.09.001
发表时间: 2018
期刊: British journal of anaesthesia
影响因子: 9.8
作者: [Duma,A, Wagner,C, Titz,M, Maleczek,M, Hüpfl,M, Weihs,VB, Samaha,E, Herkner,H, Szekeres,T, Mittlboeck,M, Scott,MG, Jaffe,AS, Nagele,P]
通讯作者: Nagele,P
DOI: 10.1053/j.jvca.2020.10.016
发表时间: 2021-03
期刊: Journal of cardiothoracic and vascular anesthesia
影响因子: 2.8
作者: [Ranjeva SL, Tung A, Nagele P, Rubin DS]
通讯作者: Rubin DS
DOI: 10.1097/aln.0000000000003984
发表时间: 2021-11-01
期刊: Anesthesiology
影响因子: 8.8
作者: [Tank A, Hughey R, Ward RP, Nagele P, Rubin DS]
通讯作者: Rubin DS
6
    NOVEL STRATEGY FOR PERIOPERATIVE BETA-BLOCKER THERAPY
    • 批准号:
      9115689
    • 项目类别:
    • 资助金额:
      $47.69万
    • 财政年份:
      2015
    • 负责人:
      Peter Nagele
    • 依托单位:
    NOVEL STRATEGY FOR PERIOPERATIVE BETA-BLOCKER THERAPY
    • 批准号:
      9266475
    • 项目类别:
    • 资助金额:
      $47.69万
    • 财政年份:
      2015
    • 负责人:
      Peter Nagele
    • 依托单位:
    NOVEL STRATEGY FOR PERIOPERATIVE BETA-BLOCKER THERAPY
    • 批准号:
      8985278
    • 项目类别:
    • 资助金额:
      $56.36万
    • 财政年份:
      2015
    • 负责人:
      Peter Nagele
    • 依托单位:
    Perioperative pharmacogenetics: Nitrous oxide and anesthetic outcomes
    • 批准号:
      7738640
    • 项目类别:
    • 资助金额:
      $11.37万
    • 财政年份:
      2010
    • 负责人:
      Peter Nagele
    • 依托单位: