Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients

Abstract

SummaryWe investigated the use of measurements of serum concentrations of the cardiac proteins troponins I and T as biochemical markers of myocardial cell damage in 80 patients undergoing vascular or major orthopaedic surgery. Holter electrocardiographic monitoring was carried out before surgery and for 3 days after surgery. Blood samples for troponins I and T and creatine kinase-MB isoenzyme were taken on each of these 4 days. Outcome was assessed at 3 months using a patient questionnaire, general practitioner follow-up and case notes review. Silent postoperative myocardial ischaemia was detected in 21 patients; increases in troponins I and T and creatine kinase-MB occurred in four, six and 17 of these patients, respectively. Eight patients suffered major postoperative complications (cardiac death, myocardial ischaemia, congestive cardiac failure, unstable angina and cerebrovascular accident) and 21 minor complications (poorly controlled hypertension needing increased or new additional treatment, palpitations, increased tiredness or shortness of breath in the absence of known respiratory disease). There were no associations between postoperative ischaemia and cardiac protein concentrations. The relative odds for the associations of major adverse outcome at 3 months after surgery and postoperative ischaemia or increased serum concentrations of the three proteins were 5.39 [95% confidence intervals 1.16±27.67] for postoperative ischaemia; 5.64 [1.07±31.00] for creatine kinase-MB isoenzyme; 17.00 [2.20±116.54] for troponin T and 13.20 [1.12±135.00] for troponin I. We found troponin T to be the only prospective marker for both major and minor cardiovascular complications (relative odds 10.65 [1.26±252.88]).

The Relationship Between Skeletal Muscle Serum Markers and Primary THA: A Pilot Study

“…Serial assays of creatine kinase (CK), creatine phosphokinase (CPK), serum myoglobin, and cardiac troponin I are laboratory tests of choice for the diagnosis of myocardial injury. Various authors report changes in these serum markers as a result of skeletal muscle injury, which also correlates with surgical incision length, surgical approach, and operative time [12,16,18,20,21,24]. These reports confirm elevations in CK, CPK, and serum myoglobin can occur after orthopaedic surgery in the absence of overt clinical manifestations of myocardial injury.…”

“…Reported use of blood enzyme markers is common throughout the surgical literature [9,12,[16][17][18][20][21][22][23][24]. Rhabdomyolysis has numerous etiologies and includes local crush injury, vascular compromise, soft tissue infections, electrical injuries, excessive steroid use, seizures, surgery, and heat stroke [1,19,22].…”

Acute peri‐operative beta blockade in intermediate‐risk patients

“…Furthermore Landesberg et al [5] have shown that prolonged postoperative myocardial ischaemia (> 30 min) is an independent predictor of long-term mortality following major vascular surgery. Postoperative myocardial ischaemia has also been associated with major cardiovascular complications within three months of surgery in patients undergoing both major and intermediate risk surgery [7]. SMI may also be predictive of adverse cardiovascular events up to a year after a range of non-cardiac surgical operations [6].…”

Effects of Dexmedetomidine Sedation on Myocardial Ischemia in Peripheral Vascular Surgery Performed Under Epidural Anaesthesia

“…Enzim sonuçlarındaki anlamlı fark klinik olarak iskemi epizodlarının süresinde de gözlenmiştir. Ancak, troponin düzeyleri, yayınlarda "majör kardiyak olayı" öngörüsünde ulaşacağı seviyeden oldukça düşük bulunmuştur (17)(18)(19) . Biccard ve ark.…”