1. Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery
- Author
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Michael J Jacka, Salim Yusuf, Tomas VanHelder, Reitze N. Rodseth, Carisi Anne Polanczyk, Gordon H. Guyatt, Amit X. Garg, Mohit Bhandari, Sadeesh Srinathan, Justin de Beer, Maria Tiboni, Bruce M Biccard, Jackie Bosch, Flávia Kessler Borges, Pablo Alonso-Coello, Michael J. Jacka, Anthony Adili, Claudia Lamas, Juan Carlos Villar, Philip J. Devereaux, Clara K Chow, Valsa Abraham, Andrea Kurz, Germán Málaga, R Ignacio Garutti, Marko Mrkobrada, Otavio Berwanger, Chew Yin Wang, Rupert M Pearse, Matthew J. McQueen, Yannick Le Manach, N T Shatin, Alben Sigamani, Ignacio Garutti, Fernando Botto, Lehana Thabane, Wojciech Szczeklik, Matthew T. V. Chan, Martin Leuwer, Mitchell Winemaker, Victoria Avram, Shirley Pettit, Giovanna Lurati Buse, Daniel I. Sessler, Sabu Thomas, Kristian Thorlund, Michael Walsh, Gerard Urrútia Cuchí, Patricia Cruz, Xavier Aguilera, Paul T. Rubery, Diane Heels-Ansdell, Peter Nagele, and Dianne Heels-Ansdell
- Subjects
Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Asymptomatic ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Troponin T ,Humans ,Medicine ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Aged ,biology ,business.industry ,Mortality rate ,General Medicine ,Odds ratio ,Middle Aged ,Prognosis ,Troponin ,Cardiovascular Diseases ,Anesthesia ,Orthopedic surgery ,Cohort ,biology.protein ,Female ,Surgery ,medicine.symptom ,business ,Biomarkers - Abstract
Background Myocardial injury after noncardiac surgery (MINS) is common and of prognostic importance. Little is known about MINS in orthopaedic surgery. The diagnostic criterion for MINS was a level of ≥0.03 ng/mL on a non-high-sensitivity troponin T (TnT) assay due to myocardial ischemia. Methods We undertook an international, prospective study of 15,103 patients ≥45 years of age who had inpatient noncardiac surgery; 3,092 underwent orthopaedic surgery. Non-high-sensitivity TnT assays were performed on postoperative days 0, 1, 2, and 3. Among orthopaedic patients, we determined (1) the prognostic relevance of the MINS diagnostic criteria, (2) the 30-day mortality rate for those with and without MINS, and (3) the probable proportion of MINS cases that would go undetected without troponin monitoring because of a lack of an ischemic symptom. Results Three hundred and sixty-seven orthopaedic patients (11.9%) had MINS. MINS was associated independently with 30-day mortality including among those who had had orthopaedic surgery. Orthopaedic patients without and with MINS had a 30-day mortality rate of 1.0% and 9.8%, respectively (odds ratio [OR], 11.28; 95% confidence interval [CI], 6.72 to 18.92). The 30-day mortality rate was increased for patients with MINS who had an ischemic feature (i.e., symptoms, or evidence of ischemia on electrocardiography or imaging) (OR, 18.25; 95% CI, 10.06 to 33.10) and for those who did not have an ischemic feature (OR, 7.35; 95% CI, 3.37 to 16.01). The proportion of orthopaedic patients with MINS who were asymptomatic and in whom the myocardial injury would have probably gone undetected without TnT monitoring was 81.3% (95% CI, 76.3% to 85.4%). Conclusions One in 8 orthopaedic patients in our study had MINS, and MINS was associated with a higher mortality rate regardless of symptoms. Troponin levels should be measured after surgery in at-risk patients because most MINS cases (>80%) are asymptomatic and would go undetected without routine measurements. Level of evidence Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
- Published
- 2020