Key result
Intraoperative dexmedetomidine reduces postoperative troponin elevation by an absolute ~14% vs saline.
Why the study?
Myocardial injury after non-cardiac surgery is a clinically important complication in patients with diabetes, and dexmedetomidine has been investigated for potential perioperative cardioprotection.
Does intraoperative dexmedetomidine reduce postoperative high-sensitivity cardiac troponin I elevation in older patients with diabetes undergoing elective abdominal surgery?
RCT (n=119)
Double-blind
Randomized
Does intraoperative dexmedetomidine reduce postoperative high-sensitivity cardiac troponin I elevation in older patients with diabetes undergoing elective abdominal surgery?
Intraoperative dexmedetomidine reduced postoperative troponin elevations above a study-specific threshold in older diabetic patients undergoing abdominal surgery, though it increased sinus bradycardia duration and did not establish prevention of conventionally defined myocardial injury after non-cardiac surgery.
Answers are grounded in this paper and cite their sources.
May reduce troponin elevation in diabetics; hypothesis-generating for MINS prevention, larger trials needed.
Background Myocardial injury after non-cardiac surgery (MINS) is a clinically important complication in patients with diabetes. Dexmedetomidine has been investigated for potential perioperative cardioprotection. The present trial evaluated postoperative troponin elevation using a study-specific threshold. Methods In this randomized, double-blind trial, 119 patients aged 60 years or older with diabetes undergoing elective abdominal surgery received intraoperative dexmedetomidine (0.4 μg/kg/h; n = 61) or saline (n = 58). The primary reported endpoint was high-sensitivity cardiac troponin I (hs-cTnI) >0.020 ng/mL at 24 or 72 hours after surgery in patients with normal preoperative values. The assay-specific 99th-percentile upper reference limit was 0.029 ng/mL. Hemodynamic, anesthetic, and postoperative outcomes were also evaluated. Results The study-specific troponin endpoint occurred in 3 of 61 dexmedetomidine recipients (4.92%) and 11 of 58 controls (18.97%). The originally reported one-sided P value was 0.017. A two-sided Fisher exact reanalysis of the event counts gave P = 0.0225. The absolute risk reduction was 14.05 percentage points (95% confidence interval [CI], 2.30 to 26.37 percentage points). Mean intraoperative heart rate and sevoflurane use were lower with dexmedetomidine, whereas cumulative sinus bradycardia duration was longer. The multivariable logistic analysis included three predictors and 14 outcome events. Conclusions In older patients with diabetes undergoing abdominal surgery, dexmedetomidine was associated with fewer postoperative hs-cTnI elevations at the study-specific >0.020 ng/mL threshold. This finding does not by itself establish prevention of conventionally defined MINS at the assay-specific 99th-percentile threshold. Lower mean intraoperative heart rate and longer sinus bradycardia duration were observed in the dexmedetomidine group. Larger studies using standardized endpoints and detailed perioperative safety reporting are warranted.
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Chang et al. (2026) conducted an RCT in Diabetes undergoing elective abdominal surgery (n=119). Intraoperative dexmedetomidine vs. Saline was evaluated on High-sensitivity cardiac troponin I (hs-cTnI) >0.020 ng/mL at 24 or 72 hours after surgery (ARR 14.05%, 95% CI 2.30-26.37, p=0.0225). Intraoperative dexmedetomidine reduced postoperative hs-cTnI elevation (>0.020 ng/mL) vs saline (4.92% vs 18.97%; ARR 14.05%, 95% CI 2.30-26.37; P=0.0225).
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