Cardiac troponin I release after hip surgery correlates with poor long-term cardiac outcome

Ausset, Sylvain; Auroy, Yves; Lambert, E.; Vest, Philippe; Plotton, C.; Rigal, S.; Lenoir, B.; Benhamou, Dan

doi:10.1017/s0265021507001202

Cited by 72 publications

(59 citation statements)

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“…Studies with vascular and other highrisk but elective surgery showed an incidence of postoperative troponin elevation of 10 to 45 percent. [23][24][25][26] The incidence of perioperative MI, as found in the present study, was 3.1%, which was not comparable to the recent observational study. 19) With regard to the definition, the incidence of perioperative MI is directly related to the sensitivity of the biomarker used.…”

Section: )contrasting

confidence: 90%

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

et al. 2016

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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...

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Section: )contrasting

confidence: 90%

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

et al. 2016

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“…These results are summarized in Table 2. In a mixed group of elective (approximately 51% of all surgeries performed in this study) and emergent hip surgery, increased cTnI was associated with in-hospital myocardial ischemia, acute coronary syndrome and other cardiac events [56]. Importantly, increased cTns were evident in patients who did not exhibit clinical symptoms of underlying cardiac perturbations, but who had a history of co-morbid cardiovascular risk factors that were likely to increase risk of cardiac events [56].…”

Section: Troponins As a Marker Of Cardiovascular Risk In Tjamentioning

confidence: 76%

“…Importantly, increased cTns were evident in patients who did not exhibit clinical symptoms of underlying cardiac perturbations, but who had a history of co-morbid cardiovascular risk factors that were likely to increase risk of cardiac events [56]. Further, increased cTnI levels were associated with mortality at 1-year and a tenfold risk of cardiac events at 1 year; however, this was primarily observed in nonelective TJA patients [56]. Thus, these biomarkers could represent an additional mechanism for identifying at-risk patients, beyond standard medical history and clinical symptoms.…”

Section: Troponins As a Marker Of Cardiovascular Risk In Tjamentioning

confidence: 99%

“…The relative risk of a 10-100-fold increase in troponin (≥0.60 μg/l) was 4.2. cTnI was an independent predictor of 30-day mortality [28] Simons et al 45-≥75 6-12 h after surgery and during the first 3 postoperative days Increased (peak) cTnT levels were associated with 30-day mortality [31] Biccard et al Before surgery and on days 1, 2, 3 postoperation 33% of patients had increased cTnI during the first 3 days after surgery from which 12% had an MI. Increased cTnI during the first 3 days after surgery was associated with major cardiac complications that occurred in the 6.6% of patients at 1 month [26] Bursi et al lar-related 30-day morbidity or mortality in patients undergoing noncardiac surgery , TJA [48][49][50][51][52][53][54][55][56][57][58][59] and to a certain degree in OSA patients [60][61][62][63][64][65][66][67][68][69][70][71][72][73]. While these biomarkers have been studied in surgical patients and OSA patients, none of these studies directly evaluated the perioperative patient with OSA undergoing noncardiac surgery or TJA.…”

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confidence: 99%

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Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

et al. 2016

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Obstructive sleep apnea (OSA) is highly prevalent in patients undergoing total joint arthroplasty (TJA) and is a major risk factor for postoperative cardiovascular complications and death. Recognizing this, the American Society of Anesthesiologists urges clinicians to implement special considerations in the perioperative care of OSA patients. However, as the volume of patients presenting for TJA increases, resources to implement these recommendations are limited. This necessitates mechanisms to efficiently risk stratify patients having OSA who may be susceptible to post-TJA cardiovascular complications. We explore the role of perioperative measurement of cardiac troponins (cTns) and brain natriuretic peptides (BNPs) in helping determine which OSA patients are at increased risk for post-TJA cardiovascular-related morbidity.

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“…Studies on the incidence of perioperative myocardial damage and its influence on cardiac complications and outcome in patients undergoing non-cardiac surgery are presented in Table 5 7, 13,14,27,53,75,76,80,[106][107][108][109][110][111][112][113][114][115][116][117][118] . These studies all show that myocardial damage, defined as a troponin elevation, is significantly correlated to adverse perioperative outcome.…”

Section: Perioperative Myocardial Damage and Outcomementioning

confidence: 99%

Perioperative myocardial damage and cardiac outcome in patients‐at‐risk undergoing non‐cardiac surgery

Tibblin¹

2010

Acta Anaesthesiol Scand

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Despite increasingly sophisticated perioperative management, cardiovascular complications continue to be major challenges for the clinician. As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing noncardiac surgery, cardiovascular complications will remain a significant clinical problem in the future. The overall objective of this thesis was to study the incidence of myocardial damage and perioperative adverse cardiac events, to determine predictors of poor outcome and to assess the effect of a medical intervention in patients at risk undergoing non-cardiac surgery. The studies in this thesis were conducted on a total of 952 patients undergoing non-cardiac surgery. Studies I and IV were multicenter studies; whereas the patients included in studies II and III underwent non-cardiac surgery at Linkoping University Hospital, Sweden. The correlation between postoperative myocardial damage and short-and long-term outcome were studied in 546 patients, aged 70 years or older undergoing non-cardiac surgery of at least 30 minutes duration. This study showed a close correlation between postoperative myocardial damage and poor short-as well as long-term outcome. Elevated Troponin T was a strong independent predictor of mortality within one year of surgery. In 186 patients with ASA physical status classification III or IV undergoing non-elective surgery, the incidence of myocardial damage was 33%. In this study preoperative myocardial damage was an independent predictor of major adverse cardiac events in the postoperative period. In 69 patients with ASA physical status classification III & IV undergoing acute hip surgery, we found a close correlation between elevated NT-proBNP value prior to surgery and cardiac complications in the postoperative period. To study the effect of acetylsalicylic acid on postoperative myocardial damage and cardiovascular events, 220 patients at risk were randomized to receive 75 mg of acetylsalicylic acid or placebo 7 days prior to surgery until the third postoperative day. This study showed that treatment with acetylsalicylic acid resulted in an 8% (95% CI 1-15%) absolute risk reduction of having a postoperative major adverse cardiac event. No statistically significant differences of bleeding complications were seen between the groups. In conclusion, this thesis contributes to the understanding of the clinical relevance of elevated cardiac markers (with or without clinical or ECG signs of myocardial damage) in patients undergoing elective or emergency surgery. Moreover, we have identified predictors of poor outcome in the perioperative period that could be used as tools for identifying patients at risk. Finally, we have shown that continuing acetylsalicylic acid in the perioperative period reduced the risk of major adverse cardiac events within 30 days of surgery.

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Cardiac troponin I release after hip surgery correlates with poor long-term cardiac outcome

Abstract: Troponin I release is common after hip surgery and is associated with a 10-fold increased incidence of long-term major cardiac events as compared to patients with normal troponin I levels (45% vs. 4%).

Cited by 72 publications

References 21 publications

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

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

Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

Perioperative myocardial damage and cardiac outcome in patients‐at‐risk undergoing non‐cardiac surgery

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