Effect of Dexamethasone on Myocardial Injury After Total Knee Arthroplasty: A Substudy of the Randomized Clinical DEX-2-TKA Trial

Asger K. Mølgaard; Kasper S. Gasbjerg; Christian S. Meyhoff; Troels H. Lunn; Janus C. Jakobsen; Ismail Gögenur; Ole Mathiesen; Daniel Hägi-Pedersen

doi:10.1016/j.amjmed.2022.09.031

Effect of Dexamethasone on Myocardial Injury After Total Knee Arthroplasty: A Substudy of the Randomized Clinical DEX-2-TKA Trial

Asger K. Mølgaard^*, Kasper S. Gasbjerg, Christian S. Meyhoff, Troels H. Lunn, Janus C. Jakobsen, Ismail Gögenur, Ole Mathiesen, Daniel Hägi-Pedersen

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

2 Citations (Scopus)

Abstract

Background: Myocardial injury after noncardiac surgery (MINS) carries a high postoperative mortality. In this preplanned, subgroup analysis of the randomized DEX-2-TKA Trial, we investigated the effect of dexamethasone versus placebo on the concentration of cardiac troponin I and T (TnI and TnT) on the first postoperative morning after total knee arthroplasty. In addition, frequency of MINS, myocardial infarction, and major adverse cardiovascular events where evaluated. Methods: We included 290 patients who received either 24 mg of dexamethasone intravenously (given perioperatively) or placebo. Blood samples were analyzed as either TnI or T depending on trial site. Results: A total of 236 samples were eligible for analysis of TnI and 38 samples for TnT on the first postoperative morning. The median (IQR) TnI concentration was 4.6 ng/L (0-7.2 ng/L) in the dexamethasone group and 4.5ng/l (0-7.0 ng/L) in the placebo group (P = .96) on the first postoperative morning. The median TnT was 9 ng/L (6-11 ng/L) in the dexamethasone group and 8 ng/L (5-10 ng/L) in the placebo group (P = .68). The frequencies of MINS, myocardial infarction, and major adverse cardiovascular events were similar in the compared groups, but these analyses were underpowered. Conclusion: We found no effect of dexamethasone on postoperative concentration of troponin I or T on the first postoperative morning after total knee arthroplasty.

Original language	English
Journal	American Journal of Medicine
Volume	136
Issue number	2
Pages (from-to)	193-199
Number of pages	7
ISSN	0002-9343
DOIs	https://doi.org/10.1016/j.amjmed.2022.09.031
Publication status	Published - 2023

Bibliographical note

Funding Information:
Conflicts of Interest : AKM, KSG, THL, JCJ, IG, OM, and DH-P report none. CSM reports being a cofounder of a start-up company, WARD247 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD-project (wireless assessment of vital signs). WARD247 ApS has finalized terms for license agreement for any WARD-project software and patents. One patent has been filed: “Wireless Assessment of Respiratory and circulatory Distress (WARD) – Clinical Support System (CSS) – an automated clinical support system to improve patient safety and outcomes” and also reports direct and indirect research funding from Merck Sharp & Dohme Corp., Radiometer and Boehringer Ingelheim, as well as lecture fees from Radiometer, all outside the submitted work.

Funding Information:
Funding: Analyses were funded by a grant from the Næstved, Slagelse, and Ringsted (NSR) Hospitals Research Fund and the Departments of Anesthesiology at NSR Hospitals and Bispebjerg Hospital. Conflicts of Interest: AKM, KSG, THL, JCJ, IG, OM, and DH-P report none. CSM reports being a cofounder of a start-up company, WARD247 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD-project (wireless assessment of vital signs). WARD247 ApS has finalized terms for license agreement for any WARD-project software and patents. One patent has been filed: “Wireless Assessment of Respiratory and circulatory Distress (WARD) – Clinical Support System (CSS) – an automated clinical support system to improve patient safety and outcomes” and also reports direct and indirect research funding from Merck Sharp & Dohme Corp., Radiometer and Boehringer Ingelheim, as well as lecture fees from Radiometer, all outside the submitted work.

Funding Information:
Funding: Analyses were funded by a grant from the Næstved, Slagelse, and Ringsted (NSR) Hospitals Research Fund and the Departments of Anesthesiology at NSR Hospitals and Bispebjerg Hospital.

Publisher Copyright:
© 2022 Elsevier Inc.

Keywords

Arthroplasty
Dexamethasone
Knee replacement
Troponin I
Troponin T

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10.1016/j.amjmed.2022.09.031

Cite this

Effect of Dexamethasone on Myocardial Injury After Total Knee Arthroplasty : A Substudy of the Randomized Clinical DEX-2-TKA Trial. / Mølgaard, Asger K.; Gasbjerg, Kasper S.; Meyhoff, Christian S.; Lunn, Troels H.; Jakobsen, Janus C.; Gögenur, Ismail ; Mathiesen, Ole ; Hägi-Pedersen, Daniel.

In: American Journal of Medicine, Vol. 136, No. 2, 2023, p. 193-199.

Research output: Contribution to journal › Journal article › Research › peer-review

Mølgaard, Asger K. ; Gasbjerg, Kasper S. ; Meyhoff, Christian S. ; Lunn, Troels H. ; Jakobsen, Janus C. ; Gögenur, Ismail ; Mathiesen, Ole ; Hägi-Pedersen, Daniel. / Effect of Dexamethasone on Myocardial Injury After Total Knee Arthroplasty : A Substudy of the Randomized Clinical DEX-2-TKA Trial. In: American Journal of Medicine. 2023 ; Vol. 136, No. 2. pp. 193-199.

@article{8969d2c1a7cf45a387f05dfe54f18367,

title = "Effect of Dexamethasone on Myocardial Injury After Total Knee Arthroplasty: A Substudy of the Randomized Clinical DEX-2-TKA Trial",

abstract = "Background: Myocardial injury after noncardiac surgery (MINS) carries a high postoperative mortality. In this preplanned, subgroup analysis of the randomized DEX-2-TKA Trial, we investigated the effect of dexamethasone versus placebo on the concentration of cardiac troponin I and T (TnI and TnT) on the first postoperative morning after total knee arthroplasty. In addition, frequency of MINS, myocardial infarction, and major adverse cardiovascular events where evaluated. Methods: We included 290 patients who received either 24 mg of dexamethasone intravenously (given perioperatively) or placebo. Blood samples were analyzed as either TnI or T depending on trial site. Results: A total of 236 samples were eligible for analysis of TnI and 38 samples for TnT on the first postoperative morning. The median (IQR) TnI concentration was 4.6 ng/L (0-7.2 ng/L) in the dexamethasone group and 4.5ng/l (0-7.0 ng/L) in the placebo group (P = .96) on the first postoperative morning. The median TnT was 9 ng/L (6-11 ng/L) in the dexamethasone group and 8 ng/L (5-10 ng/L) in the placebo group (P = .68). The frequencies of MINS, myocardial infarction, and major adverse cardiovascular events were similar in the compared groups, but these analyses were underpowered. Conclusion: We found no effect of dexamethasone on postoperative concentration of troponin I or T on the first postoperative morning after total knee arthroplasty.",

keywords = "Arthroplasty, Dexamethasone, Knee replacement, Troponin I, Troponin T",

author = "M{\o}lgaard, {Asger K.} and Gasbjerg, {Kasper S.} and Meyhoff, {Christian S.} and Lunn, {Troels H.} and Jakobsen, {Janus C.} and Ismail G{\"o}genur and Ole Mathiesen and Daniel H{\"a}gi-Pedersen",

note = "Funding Information: Conflicts of Interest : AKM, KSG, THL, JCJ, IG, OM, and DH-P report none. CSM reports being a cofounder of a start-up company, WARD247 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD-project (wireless assessment of vital signs). WARD247 ApS has finalized terms for license agreement for any WARD-project software and patents. One patent has been filed: “Wireless Assessment of Respiratory and circulatory Distress (WARD) – Clinical Support System (CSS) – an automated clinical support system to improve patient safety and outcomes” and also reports direct and indirect research funding from Merck Sharp & Dohme Corp., Radiometer and Boehringer Ingelheim, as well as lecture fees from Radiometer, all outside the submitted work. Funding Information: Funding: Analyses were funded by a grant from the N{\ae}stved, Slagelse, and Ringsted (NSR) Hospitals Research Fund and the Departments of Anesthesiology at NSR Hospitals and Bispebjerg Hospital. Conflicts of Interest: AKM, KSG, THL, JCJ, IG, OM, and DH-P report none. CSM reports being a cofounder of a start-up company, WARD247 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD-project (wireless assessment of vital signs). WARD247 ApS has finalized terms for license agreement for any WARD-project software and patents. One patent has been filed: “Wireless Assessment of Respiratory and circulatory Distress (WARD) – Clinical Support System (CSS) – an automated clinical support system to improve patient safety and outcomes” and also reports direct and indirect research funding from Merck Sharp & Dohme Corp., Radiometer and Boehringer Ingelheim, as well as lecture fees from Radiometer, all outside the submitted work. Funding Information: Funding: Analyses were funded by a grant from the N{\ae}stved, Slagelse, and Ringsted (NSR) Hospitals Research Fund and the Departments of Anesthesiology at NSR Hospitals and Bispebjerg Hospital. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2023",

doi = "10.1016/j.amjmed.2022.09.031",

language = "English",

volume = "136",

pages = "193--199",

journal = "American Journal of Medicine",

issn = "0002-9343",

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TY - JOUR

T1 - Effect of Dexamethasone on Myocardial Injury After Total Knee Arthroplasty

T2 - A Substudy of the Randomized Clinical DEX-2-TKA Trial

AU - Mølgaard, Asger K.

AU - Gasbjerg, Kasper S.

AU - Meyhoff, Christian S.

AU - Lunn, Troels H.

AU - Jakobsen, Janus C.

AU - Gögenur, Ismail

AU - Mathiesen, Ole

AU - Hägi-Pedersen, Daniel

N1 - Funding Information: Conflicts of Interest : AKM, KSG, THL, JCJ, IG, OM, and DH-P report none. CSM reports being a cofounder of a start-up company, WARD247 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD-project (wireless assessment of vital signs). WARD247 ApS has finalized terms for license agreement for any WARD-project software and patents. One patent has been filed: “Wireless Assessment of Respiratory and circulatory Distress (WARD) – Clinical Support System (CSS) – an automated clinical support system to improve patient safety and outcomes” and also reports direct and indirect research funding from Merck Sharp & Dohme Corp., Radiometer and Boehringer Ingelheim, as well as lecture fees from Radiometer, all outside the submitted work. Funding Information: Funding: Analyses were funded by a grant from the Næstved, Slagelse, and Ringsted (NSR) Hospitals Research Fund and the Departments of Anesthesiology at NSR Hospitals and Bispebjerg Hospital. Conflicts of Interest: AKM, KSG, THL, JCJ, IG, OM, and DH-P report none. CSM reports being a cofounder of a start-up company, WARD247 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD-project (wireless assessment of vital signs). WARD247 ApS has finalized terms for license agreement for any WARD-project software and patents. One patent has been filed: “Wireless Assessment of Respiratory and circulatory Distress (WARD) – Clinical Support System (CSS) – an automated clinical support system to improve patient safety and outcomes” and also reports direct and indirect research funding from Merck Sharp & Dohme Corp., Radiometer and Boehringer Ingelheim, as well as lecture fees from Radiometer, all outside the submitted work. Funding Information: Funding: Analyses were funded by a grant from the Næstved, Slagelse, and Ringsted (NSR) Hospitals Research Fund and the Departments of Anesthesiology at NSR Hospitals and Bispebjerg Hospital. Publisher Copyright: © 2022 Elsevier Inc.

PY - 2023

Y1 - 2023

N2 - Background: Myocardial injury after noncardiac surgery (MINS) carries a high postoperative mortality. In this preplanned, subgroup analysis of the randomized DEX-2-TKA Trial, we investigated the effect of dexamethasone versus placebo on the concentration of cardiac troponin I and T (TnI and TnT) on the first postoperative morning after total knee arthroplasty. In addition, frequency of MINS, myocardial infarction, and major adverse cardiovascular events where evaluated. Methods: We included 290 patients who received either 24 mg of dexamethasone intravenously (given perioperatively) or placebo. Blood samples were analyzed as either TnI or T depending on trial site. Results: A total of 236 samples were eligible for analysis of TnI and 38 samples for TnT on the first postoperative morning. The median (IQR) TnI concentration was 4.6 ng/L (0-7.2 ng/L) in the dexamethasone group and 4.5ng/l (0-7.0 ng/L) in the placebo group (P = .96) on the first postoperative morning. The median TnT was 9 ng/L (6-11 ng/L) in the dexamethasone group and 8 ng/L (5-10 ng/L) in the placebo group (P = .68). The frequencies of MINS, myocardial infarction, and major adverse cardiovascular events were similar in the compared groups, but these analyses were underpowered. Conclusion: We found no effect of dexamethasone on postoperative concentration of troponin I or T on the first postoperative morning after total knee arthroplasty.

AB - Background: Myocardial injury after noncardiac surgery (MINS) carries a high postoperative mortality. In this preplanned, subgroup analysis of the randomized DEX-2-TKA Trial, we investigated the effect of dexamethasone versus placebo on the concentration of cardiac troponin I and T (TnI and TnT) on the first postoperative morning after total knee arthroplasty. In addition, frequency of MINS, myocardial infarction, and major adverse cardiovascular events where evaluated. Methods: We included 290 patients who received either 24 mg of dexamethasone intravenously (given perioperatively) or placebo. Blood samples were analyzed as either TnI or T depending on trial site. Results: A total of 236 samples were eligible for analysis of TnI and 38 samples for TnT on the first postoperative morning. The median (IQR) TnI concentration was 4.6 ng/L (0-7.2 ng/L) in the dexamethasone group and 4.5ng/l (0-7.0 ng/L) in the placebo group (P = .96) on the first postoperative morning. The median TnT was 9 ng/L (6-11 ng/L) in the dexamethasone group and 8 ng/L (5-10 ng/L) in the placebo group (P = .68). The frequencies of MINS, myocardial infarction, and major adverse cardiovascular events were similar in the compared groups, but these analyses were underpowered. Conclusion: We found no effect of dexamethasone on postoperative concentration of troponin I or T on the first postoperative morning after total knee arthroplasty.

KW - Arthroplasty

KW - Dexamethasone

KW - Knee replacement

KW - Troponin I

KW - Troponin T

U2 - 10.1016/j.amjmed.2022.09.031

DO - 10.1016/j.amjmed.2022.09.031

M3 - Journal article

C2 - 36252718

AN - SCOPUS:85143498986

VL - 136

SP - 193

EP - 199

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 2

ER -