Troponin-I Level After Major Noncardiac Surgery and Its Association With Long-Term Mortality

Abstract

SummaryIndividuals with intermediate to high cardiac risk for major noncardiac surgery suffer from perioperative myocardial ischemic injury. The purpose of this study was to evaluate the long-term impact of postoperative cardiac troponin elevation on clinical outcome after major noncardiac surgery.Patients (n = 750) aged ≥ 50 years who underwent major noncardiac surgery were eligible for the study. Postoperative cardiac troponin-I data were collected retrospectively and consecutively. The primary outcome measure was allcause mortality. The median follow-up period was 1727 days in all patients.Among 750 patients, 92 (12.2%) showed elevated postoperative troponin-I above 0.10 ng/mL. Operative mortality was 4.1% (31 subjects), and patients with troponin-I elevation showed a higher operative mortality rate (RR: 4.23, 95% CI: 2.67-11.31, P < 0.001). In multivariate Cox regression analysis, a troponin-I concentration above 0.10 ng/mL was associated with all-cause mortality (RR: 1.73, 95% CI: 1.27-2.36, P < 0.001). It should be noted that there was a significant difference between patients with elevated and non-elevated troponin-I in the rate of mortality until 6 months. However, these differences disappeared after 6 months. An elevated troponin-I level conferred an increase in mortality during the 7 year follow-up period after major noncardiac surgery. This difference in mortality was mainly derived from the result within the first 6 months. (Int Heart J 2016; 57: 278-284) Key words: Myocardial ischemia, Death, Surgical procedures A ll surgical procedures elicit a stress response, although the extent of the response depends on the extent of the surgery and the use of anesthetics and analgesics that are used to reduce the response. The stress response can lead to increases in heart rate and blood pressure, which can precipitate episodes of myocardial ischemia. 1)Individuals with intermediate to high cardiac risk for noncardiac surgery suffer from perioperative myocardial ischemic injury.2) Cardiac troponins are a useful tool that help clinicians in making the diagnosis of perioperative myocardial infarction.3-5) Many previous studies have investigated the role of cardiac troponins in the diagnosis of perioperative myocardial ischemic events and demonstrated the prognostic value of postoperative cardiac troponin elevation.6-9) A recent metaanalysis of studies in predominantly high-risk surgery patients also showed that cardiac troponin elevation was a strong independent predictor of mortality within the first year after surgery. 10) Editorial p.265The development of perioperative cardiovascular complications not only affects the short-term period prognosis but may also influence the long-term consequences. However, few studies have explored the long-term, defined as beyond the first year after major noncardiac surgery, prognostic value of cardiac troponin elevation in the prediction of postoperative outcome. We undertook this study to evaluate the clinical outcome of cardiac troponin elevation after major noncardiac sur...

Type 2 versus type 1 myocardial infarction: a comparison of clinical characteristics and outcomes with a meta-analysis of observational studies

“…This is a novel finding differs from the one found by Javed et al and Haddad et al where sepsis was the most common trigger. Elevation in troponin I can occur after noncardiac surgery in patients without CAD (24). In a study by Gualandro et al (25), nearly 50% of patients with postoperative acute coronary syndrome had no evidence of plaque rupture.…”

Cardiovascular complications after non‐cardiac surgery

“…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.…”

Cardiac Troponin as a Specific and Non-Specific Biomarker for Cardiovascular Events

“…In a retrospective study of 750 patients who underwent major noncardiac surgery, Kim, et al reported that the cTnI level at postoperative day 1-2 was significantly correlated with all causes of death after surgery, and cTnI elevations predicted death in a dose-related manner. 2) Moreover, analysis of several years of follow-up revealed that this significant relationship between postoperative cTnI level and mortality disappeared after 6 months of major noncardiac surgery. This prediction of death based on cTn elevations was consistent with previous studies.…”

“…3,4) The operative mortality of 4.1% in the study population by Kim, et al was relatively high in comparison with previous studies. 2) This may be attributed to their study limitations that included a small sample size, a single center trial, and retrospective design, amongst others. Importantly however, the facts reported by Kim, et al were the first published data from Korea, included a long period of follow-up, and were consistent with several previous reports.…”