Immediate postoperative high-sensitivity troponin T concentrations and long-term patient-reported health-related quality of life

Abstract

BACKGROUND Myocardial injury after noncardiac surgery is associated with mortality and major adverse postoperative cardiovascular events. The effect of postoperative troponin concentrations on patient-reported health-related quality of life (HRQoL) is unknown. OBJECTIVE The study examined the association between immediate postoperative troponin concentrations and selfreported HRQoL 1 year after surgery. DESIGN Prospective cohort study. SETTING Single-centre tertiary care hospital in the Netherlands between July 2012 and 2015. PATIENTS Patients aged at least 60 years undergoing moderate and major noncardiac surgery. INTERVENTION None. MAIN OUTCOME MEASURES HRQoL total score was assessed with the EuroQol five-dimensional questionnaire. Tobit regression analysis was used to determine the association between postoperative troponin concentrations and 1-year HRQoL. Peak high-sensitivity troponin T values were divided into four categories: less than 14, 14 to 49, 50 to 149 and at least 150 ng l À1. RESULTS A total of 3085 patients with troponin measurements were included. 2634 (85.4%) patients were alive at 1year follow-up of whom 1297 (49.2%) returned a completed questionnaire. The median score for HRQoL was 0.82 (0.85, 0.81, 0.77 and 0.71 per increasing troponin category). Multivariable analysis revealed betas of À0.06 [95% confidence interval (CI) À0.09 to À0.02], À0.11 (95% CI À0.18 to À0.04) and À0.18 (95% CI À0.29 to À0.07) for troponin levels of 14 to 49, 50 to 149 and at least 150 ng l À1 when compared with values less than 14 ng l À1. Other independent predictors for lower HRQoL were chronic obstructive pulmonary disease, female sex, peripheral arterial disease and increasing age. CONCLUSION Higher levels of postoperative troponin measured immediately after surgery were independently associated with lower self-reported HRQoL total score at 1-year follow-up.

Intraoperative Variables Enhance the Predictive Performance of Myocardial Injury in Patients with High Cardiovascular Risk After Thoracic Surgery When Added to Baseline Prediction Model

“… 4–6 A cohort study of 3085 patients showed that the higher postoperative troponin level was independently related to the lower self-reported score of Health-Related Quality of Life (HRQoL) at one-year follow-up. 7 …”

“…[4][5][6] A cohort study of 3085 patients showed that the higher postoperative troponin level was independently related to the lower self-reported score of Health-Related Quality of Life (HRQoL) at one-year follow-up. 7 Pathological and physiological causes of MINS are varied, and the imbalance of oxygen supply or demand is considered the main cause of MINS. 8 The patients undergoing thoracic surgery are aging gradually.…”