Troponin I as a Diagnostic Marker of a Perioperative Myocardial Infarction in the Orthopedic Population

Jules-Elysée, Kethy M.; Urban, Mi­chael; Urquhart, Barbara; Milman, Steven

doi:10.1016/s0952-8180(01)00337-3

Cited by 50 publications

(10 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study is the largest series of subjects undergoing major orthopedic surgery with troponin measurements and long-term follow-up. Our data support the findings of small orthopedic surgery studies, 9–14,19,20 and augment the short-term results of large prospective registries of subjects undergoing non-cardiac surgery. 15,16 In the large, prospective Vascular Events in Non-Cardiac Surgery Subjects Cohort Evaluation (VISION) study, elevated perioperative troponin elevations correlated with 30-day mortality.…”

Section: Discussionsupporting

confidence: 86%

Relation of Perioperative Elevation of Troponin to Long-Term Mortality After Orthopedic Surgery

Oberweis¹,

Smilowitz²,

Nukala³

et al. 2015

The American Journal of Cardiology

View full text Add to dashboard Cite

Background Myocardial necrosis in the perioperative period of non-cardiac surgery is associated with short-term mortality, but the effect on long-term outcomes has not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of subjects undergoing major orthopedic surgery. Methods We performed a long-term follow-up study of consecutive subjects undergoing hip, knee, and spine surgery between November 1, 2008 and December 31, 2009. Patient demographics and comorbidities were ascertained using a hospital administrative dataset. Perioperative myocardial necrosis and ICD-9 coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index (SSDI) database. Logistic regression models were used to identify independent predictors of long-term mortality. Results A total of 3,075 subjects underwent orthopedic surgery. Mean age was 60.7 years and a majority of subjects (59%) were female. Post-operative troponin was measured in 1060 (34.5%) subjects. Myocardial necrosis occurred in 179 (5.3%%) subjects and MI was coded in 20 (0.7%). Over 9,096 patient-years of follow up, 111 (3.6%) deaths occurred. Long-term mortality was 16.8% among subjects with myocardial necrosis, 5.8% with a troponin in the normal range, and 1.5% when a perioperative troponin was not measured. Perioperative troponin elevation (HR 2.33, CI 1.33 – 4.10) and coded post-operative MI (adjusted HR 3.51, CI 1.44 – 8.53) were significantly associated with long-term mortality after multivariable adjustment. Conclusions Post-operative myocardial necrosis is common following orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality and may be used to identify subjects at higher risk for cardiovascular events who may benefit from aggressive management of cardiovascular risk factors.

show abstract

Section: Discussionsupporting

confidence: 86%

Relation of Perioperative Elevation of Troponin to Long-Term Mortality After Orthopedic Surgery

Oberweis¹,

Smilowitz²,

Nukala³

et al. 2015

The American Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…The introduction of plasma troponin I (cTnI) analysis has markedly increased our ability to detect postoperative myocardial events because plasma elevations in this protein are highly suggestive for cardiac injury. In addition, cTnI has been shown to be a more specific marker for PMI than creatine phosphokinase (CPK) after orthopedic surgery [ 1 , 11 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

The Incidence of Perioperative Cardiac Events after Orthopedic Surgery: A Single Institutional Experience of Cases Performed over One Year

Urban

Wolfe

Sanghavi

et al. 2017

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

Self Cite

View full text Add to dashboard Cite

BackgroundOrthopedic patients with ischemic heart disease are at risk for postoperative cardiac complications.Questions/PurposesUsing information from two medical information retrieval systems which insured the capture of all events for the period of study, our goals were to determine the incidence of myocardial injury in at-risk patients after orthopedic surgery and to delineate the type and incidence of cardiac complications in this population.MethodsFor one year, at an orthopedic hospital, we identified all postoperative patients with a measured cTnI level using an electronic ordering system. Preoperative cardiac risk factors and postoperative cardiac complications were identified in patients undergoing a total hip arthroplasty (THA), total knee arthroplasty (TKA), and posterior spinal fusion (PSF). A postoperative myocardial infarction was defined by a cTnI > 0.1 ng/mL, ECG changes, new echocardiographic regional wall motion abnormalities, and evaluation by a cardiologist. Categorical variables were compared among groups with a Fisher’s exact or Chi-square test. Continuous variables were compared among groups with ANOVA or the Kruskal-Wallis test. The associations of cardiac risk factors with myocardial injury are expressed as odds ratios from logistic regression models.ResultsDuring a one-year period, from 10,627 inpatient orthopedic procedures, 805 patients were identified as at risk for postoperative myocardial ischemia. A total of 20.6% (166/805) of these patients had elevated serum cTnI levels (cTnI > 0.02 ng/mL), and there were ten documented postoperative MIs (10/805; 1.2%). For the at-risk TKA, THA, or PSF patients, 19% (102/532) had elevated cTnI levels and 31% (32/102) had postoperative cardiac complications, including arrhythmias (56%), congestive heart failure (2%), and MI (1%). Adjusting for sex, age, BMI, cardiac risk factors, and medications (statins and β-blockers), PSF patients had 3.9 times the risk of myocardial injury (p = 0.003) compared to TKA patients and 4.2 times that of THA patients.ConclusionsThe incidence of postoperative myocardial ischemia after major orthopedic surgery in patients with cardiac risk factors is high (8.7%), but the incidence of documented myocardial infarctions and serious cardiac complications remains low (1.2–2%). Patients with higher postoperative cTnI releases were more likely to have cardiac complications, and some procedures (spinal fusions) placed the patients at a higher risk.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-017-9561-9) contains supplementary material, which is available to authorized users.

show abstract

“…We have previously described the utility of examining serum cardiac proteins (troponins I and T, and creatine kinase‐MB) as predictors of postoperative cardiovascular complications within 3 months of surgery in patients undergoing orthopaedic or vascular surgery [1]. Other authors have reported the use of measuring plasma concentrations of both troponins in the prediction of early major cardiovascular complications (myocardial infarction; unstable angina; left ventricular failure, serious potentially lethal arrhythmias requiring immediate treatment; cardiac death) [2–6]. However, fewer data are available on the utility of the measurement of serum troponins or creatine kinase‐MB in the prediction of major cardiac complications (including cardiac death) up to 1 year after surgery.…”

mentioning

confidence: 99%

Peri‐operative troponin I concentration as a marker of long‐term postoperative adverse cardiac outcomes – A study in high‐risk surgical patients

Higham

Sear²,

Sear³

et al. 2004

Anaesthesia

View full text Add to dashboard Cite

SummaryWe have previously demonstrated that the peri-operative measurement of increased serum concentrations of the cardiac markers troponins I and T and creatine kinase-MB can be predictors of major cardiovascular outcomes (including cardiac death) at 3 months after surgery. In the present study, we have followed the postoperative course of 157 patients undergoing major vascular surgery or major joint arthroplasty to 1 year using a patient questionnaire, general practitioner follow-up and casenotes review. Increased postoperative marker concentrations were defined as values greater than the upper reference limit. Increases in troponin I and troponin T concentrations, as well as a single elevated creatine kinase-MB and two successively elevated creatine kinase-MB concentrations were measured in 12, 13, 33 and 15 patients respectively. Thirty-nine major adverse cardiac outcomes were recorded (cardiac death, myocardial ischaemia, congestive cardiac failure, unstable angina, cerebrovascular accident and major arrhythmias needing active treatment). There was no association between increases in any of these cardiac markers and cardiac death to 1 year. However, increases in troponin I and both a single elevated creatine kinase-MB and two successively elevated creatine kinase-MB concentrations were associated with an increased incidence of major cardiac outcomes, including cardiac death, to 1 year (odds ratio We have previously described the utility of examining serum cardiac proteins (troponins I and T, and creatine kinase-MB) as predictors of postoperative cardiovascular complications within 3 months of surgery in patients undergoing orthopaedic or vascular surgery [1]. Other authors have reported the use of measuring plasma concentrations of both troponins in the prediction of early major cardiovascular complications (myocardial infarction; unstable angina; left ventricular failure, serious potentially lethal arrhythmias requiring immediate treatment; cardiac death) [2][3][4][5][6]. However, fewer data are available on the utility of the measurement of serum troponins or creatine kinase-MB in the prediction of major cardiac complications (including cardiac death) up to 1 year after surgery.[In this study, we looked for peri-operative changes in three cardiac injury markers (serum creatine kinase-MB and troponins I and T) after anaesthesia and surgery in highrisk patients aged > 45 years, and we have followed the patients for 1 year after surgery in order to identify adverse cardiac complications. We have then determined the associations between increased serum markers and adverse outcome. Methods

show abstract

Troponin I as a Diagnostic Marker of a Perioperative Myocardial Infarction in the Orthopedic Population

Cited by 50 publications

References 23 publications

Relation of Perioperative Elevation of Troponin to Long-Term Mortality After Orthopedic Surgery

Relation of Perioperative Elevation of Troponin to Long-Term Mortality After Orthopedic Surgery

The Incidence of Perioperative Cardiac Events after Orthopedic Surgery: A Single Institutional Experience of Cases Performed over One Year

Peri‐operative troponin I concentration as a marker of long‐term postoperative adverse cardiac outcomes – A study in high‐risk surgical patients

Contact Info

Product

Resources

About