Troponin Elevation After Colorectal Surgery

Görgün, Emre; Lan, Billy; Aydinli, H. Hande; Reed, Grant W.; Menon, Venu; Sessler, Daniel I.; Stocchi, Luca; Remzi, Feza H.

doi:10.1097/sla.0000000000001854

Cited by 19 publications

(22 citation statements)

References 15 publications

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“…Therefore, all-cause mortality within 1-year follow-up was analyzed as a primary end point in this study. Elevation of hs-cTnI after surgery has been reported to be associated with postoperative myocardial infarction in non-cardiac surgery [17–19]. However, most of previous studies have focused on elevation of postoperative hs-cTnI level and routine follow-up in postoperative period is still on debate [17].…”

Section: Discussionmentioning

confidence: 99%

Preoperative cardiac troponin level is associated with all-cause mortality of liver transplantation recipients

et al. 2017

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This study was aimed to evaluate the association between preoperative high-sensitivity cardiac troponin I (hs-cTnI) level and mortality in patients undergoing liver transplantation (LT). From January 2011 to May 2016, preoperative hs-cTnI level was measured in consecutive 487 patients scheduled for LT. Patients with elevated preoperative hs-cTnI were compared with those who had normal level. The primary outcome was all-cause death in follow-up period of 30 days to 1 year after operation. Of the 487 patients, 58 (11.9%) had elevated preoperative hs-cTnI and 429 (88.1%) had normal preoperative hs-cTnI. In multivariate analysis, the rate of 1-year mortality and 30-day mortality were higher in elevated preoperative hs-cTnI group (hazard ratio [HR], 3.69; confidence interval [CI] 95%, 1.83–7.42; p < 0.001, HR, 6.61; CI, 1.91–22.82; p = 0.003, respectively). After adjustment with inverse probability weighting (IPW), the incidence of 1-year mortality and 30-day mortality were higher in elevated group (HR, 4.66; CI, 3.56–6.1; p < 0.001, HR, 10.31; CI, 6.39–16.66; p < 0.001, respectively). In conclusion, this study showed that in patients who underwent LT, elevation of preoperative hs-cTnI level was associated with 1-year mortality and 30-day mortality.

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Section: Discussionmentioning

confidence: 99%

Preoperative cardiac troponin level is associated with all-cause mortality of liver transplantation recipients

et al. 2017

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“…Many studies have utilised serial high‐sensitivity troponin assays postoperatively, examining the link between postoperative troponin rise and risk of 30‐day as well as long‐term mortality and MACE . The exact methodology and assays used varies among these studies, but certain themes occur consistently: troponin rises are common (occurring in 10–15% of patients over 45 with in‐patient surgery); only a minority of patients met the universal definition of MI; and clinically silent troponin rises, which were non‐diagnostic of MI, still conferred significant increases in mortality risk.…”

Section: Myocardial Insult Ischaemia and Infarctionmentioning

confidence: 99%

Cardiovascular complications after non‐cardiac surgery

2018

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SummaryCardiac complications are common after non-cardiac surgery. Peri-operative myocardial infarction occurs in 3% of patients undergoing major surgery. Recently, however, our understanding of the epidemiology of these cardiac events has broadened to include myocardial injury after non-cardiac surgery, diagnosed by an asymptomatic troponin rise, which also carries a poor prognosis. We review the causation of myocardial injury after non-cardiac surgery, with potential for prevention and treatment, based on currently available international guidelines and landmark studies. Postoperative arrhythmias are also a frequent cause of morbidity, with atrial fibrillation and QT-prolongation having specific relevance to the peri-operative period. Postoperative systolic heart failure is rare outside of myocardial infarction or cardiac surgery, but the impact of pre-operative diastolic dysfunction and its ability to cause postoperative heart failure is increasingly recognised. The latest evidence regarding diastolic dysfunction and the impact on non-cardiac surgery are examined to help guide fluid management for the noncardiac anaesthetist.

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“…[28][29][30] Colorectal patients are generally older, have multiple comorbidities and are placed under severe cardiac stress due to sepsis or blood loss. 27 In our study, the patient numbers are too small to draw any conclusion, and this will need further analysis with a bigger sample size.…”

Section: Discussionmentioning

confidence: 83%

“…The causes of death were non-cardiac, suggesting that troponin elevation after surgery is prognostic in a general sense, identifying patients with poor functional reserve at higher risk of mortality. 27 . Indeed, elevated troponin levels have been associated with increased all-cause mortality in a variety of settings, including sepsis, acute respiratory failure and gastrointestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%