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

• Published in: The American journal of cardiology 2015-06, Vol.115 (12), p.1643-1648
• Main Authors: Oberweis, Brandon S., MD, Smilowitz, Nathaniel R., MD, Nukala, Swetha, MBBS, Rosenberg, Andrew, MD, Xu, Jinfeng, PhD, Stuchin, Steven, MD, Iorio, Richard, MD, Errico, Thomas, MD, Radford, Martha J., MD, Berger, Jeffrey S., MD, MS
• Format: Article
• Language: English
• Subjects: Age; Aged; Biomarkers - blood; Bone surgery; Cardiovascular; Cardiovascular disease; Comorbidity; Confidence intervals; Coronary vessels; Deaths; Diabetes; Female; Follow-Up Studies; Gangrene; Heart attacks; Heart failure; Humans; Laboratories; Male; Middle Aged; Morbidity; Mortality; Multivariate analysis; Myocardial Infarction - blood; Myocardial Infarction - mortality; Necrosis; Orthopedic Procedures; Perioperative Period; Postoperative Complications - blood; Postoperative Complications - mortality; Postoperative period; Predictive Value of Tests; Retrospective Studies; Risk Factors; Stroke; Studies; Troponin - blood; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.03.003

Myocardial necrosis in the perioperative period of noncardiac surgery is associated with short-term mortality, but long-term outcomes have not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of consecutive subjects who underwent hip, knee, and spine surgery. Perioperative myocardial necrosis and International Classification of Disease, Ninth Revision –coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index database. Logistic regression models were used to identify independent predictors of long-term mortality. A total of 3,050 subjects underwent surgery. Mean age was 60.8 years, and 59% were women. Postoperative troponin was measured in 1,055 subjects (34.6%). Myocardial necrosis occurred in 179 cases (5.9%), and MI was coded in 20 (0.7%). Over 9,015 patient-years of follow-up, 111 deaths (3.6%) occurred. Long-term mortality was 16.8% in subjects with myocardial necrosis and 5.8% with a troponin in the normal range. Perioperative troponin elevation (hazard ratio 2.33, 95% confidence interval 1.33 to 4.10) and coded postoperative MI (adjusted hazard ratio 3.51, 95% confidence interval 1.44 to 8.53) were significantly associated with long-term mortality after multivariable adjustment. After excluding patients with coronary artery disease and renal dysfunction, myocardial necrosis remained associated with long-term mortality. In conclusion, postoperative myocardial necrosis is common after orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality at 3 years and may be used to identify patients at higher risk for events who may benefit from aggressive management of cardiovascular risk factors.