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Myocardial Injury After Noncardiac Surgery and its Association With Short-Term Mortality

2013; Lippincott Williams & Wilkins; Volume: 127; Issue: 23 Linguagem: Inglês

10.1161/circulationaha.113.002128

1524-4539

Judith A. R. van Waes, Hendrik M. Nathoe, Jurgen C. de Graaff, Hans Kemperman, Gert Jan de Borst, Linda M. Peelen, Wilton A. van Klei, Wolfgang Bühre, Jurgen C. de Graaff, Cor J. Kalkman, Wilton A. van Klei, Judith A. R. van Waes, Leo van Wolfswinkel, Pieter A. Doevendans, Hendrik M. Nathoe, Remco G. Grobben, D. E. Grobbee, Linda M. Peelen, Hans Kemperman, Wouter W. van Solinge, Tim Leiner, Gert Jan de Borst, Luke P. H. Leenen, Frans L. Moll,

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Background— To identify patients at risk for postoperative myocardial injury and death, measuring cardiac troponin routinely after noncardiac surgery has been suggested. Such monitoring was implemented in our hospital. The aim of this study was to determine the predictive value of postoperative myocardial injury, as measured by troponin elevation, on 30-day mortality after noncardiac surgery. Methods and Results— This observational, single-center cohort study included 2232 consecutive intermediate- to high-risk noncardiac surgery patients aged ≥60 years who underwent surgery in 2011. Troponin was measured on the first 3 postoperative days. Log binomial regression analysis was used to estimate the association between postoperative myocardial injury (troponin I level >0.06 μg/L) and all-cause 30-day mortality. Myocardial injury was found in 315 of 1627 patients in whom troponin I was measured (19%). All-cause death occurred in 56 patients (3%). The relative risk of a minor increase in troponin (0.07–0.59 μg/L) was 2.4 (95% confidence interval, 1.3–4.2; P <0.01), and the relative risk of a 10- to 100-fold increase in troponin (≥0.60 μg/L) was 4.2 (95% confidence interval, 2.1–8.6; P <0.01). A myocardial infarction according to the universal definition was diagnosed in 10 patients (0.6%), of whom 1 (0.06%) had ST-segment elevation myocardial infarction. Conclusions— Postoperative myocardial injury is an independent predictor of 30-day mortality after noncardiac surgery. Implementation of postoperative troponin monitoring as standard of care is feasible and may be helpful in improving the prognosis of patients undergoing noncardiac surgery.