Key result
Cumulative duration of SpO2 < 85% was significantly associated with myocardial injury (mean difference 14.2 min; 95% CI -4.7 to 33.1; p=0.005).
Why the study?
Intermittent cardiac biomarker screening delays diagnosis of often asymptomatic myocardial injury, prompting investigation into whether continuously monitored vital signs deviations associate with subsequent injury.
Is cumulative duration of SpO2 < 85% associated with subsequent myocardial injury in high-risk hospitalized patients?
Observational (n=662)
Is cumulative duration of SpO2 < 85% associated with subsequent myocardial injury in high-risk hospitalized patients?
Mean Difference: 14.2 (95% CI -4.7–33.1)
p-value: p=.005
Continuous wireless monitoring detecting severely low SpO2 is significantly associated with subsequent myocardial injury in high-risk hospitalized patients.
Vital sign deviations may proxy early myocardial injury; hypothesis-generating in Level 4 data and needs prospective validation before practice change.
Background Patients are at risk of myocardial injury after major non‐cardiac surgery and during acute illness. Myocardial injury is associated with mortality, but often asymptomatic and currently detected through intermittent cardiac biomarker screening. This delays diagnosis, where vital signs deviations may serve as a proxy for early signs of myocardial injury. This study aimed to assess the association between continuous monitored vital sign deviations and subsequent myocardial injury following major abdominal cancer surgery and during acute exacerbation of chronic obstructive pulmonary disease. Methods Patients undergoing major abdominal cancer surgery or admitted with acute exacerbation of chronic obstructive pulmonary disease had daily troponin measurements. Continuous wireless monitoring of several vital signs was performed for up to 96 h after admission or surgery. The primary exposure was cumulative duration of peripheral oxygen saturation (SpO 2 ) below 85% in the 24 h before the primary outcome of myocardial injury, defined as a new onset ischaemic troponin elevation assessed daily. If no myocardial injury occurred, the primary exposure was based on the first 24 h of measurement. Results A total of 662 patients were continuously monitored and 113 (17%) had a myocardial injury. Cumulative duration of SpO 2 < 85% was significantly associated with myocardial injury (mean difference 14.2 min [95% confidence interval −4.7 to 33.1 min]; p = .005). Durations of hypoxaemia (SpO 2 < 88% and SpO 2 < 80%), tachycardia (HR > 110 bpm and HR > 130 bpm) and tachypnoea (RR > 24 min −1 and RR > 30 min −1 ) were also significantly associated with myocardial injury ( p < .04, for all). Conclusion Duration of severely low SpO 2 detected by continuous wireless monitoring is significantly associated with myocardial injury in high‐risk patients admitted to hospital wards. The effect of early detection and interventions should be assessed next.
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Loft et al. (2022) conducted an observational in Major abdominal cancer surgery or acute exacerbation of chronic obstructive pulmonary disease (n=662). Cumulative duration of SpO2 < 85% was evaluated on Myocardial injury (new onset ischaemic troponin elevation) (MD 14.2, 95% CI -4.7 to 33.1, p=.005). Cumulative duration of SpO2 < 85% was significantly associated with myocardial injury (mean difference 14.2 min; 95% CI -4.7 to 33.1; p=0.005).
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