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

TitleRelation of Perioperative Elevation of Troponin to Long-Term Mortality After Orthopedic Surgery
Authors
Issue Date2015
PublisherElsevier Inc. The Journal's web site is located at http://www.ajconline.org/
Citation
The American Journal of Cardiology, 2015, v. 115, p. 1643-1648 How to Cite?
AbstractMyocardial 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.
Persistent Identifierhttp://hdl.handle.net/10722/221692
ISSN
2015 Impact Factor: 3.154
2015 SCImago Journal Rankings: 2.063
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorOberweis, BS-
dc.contributor.authorSmilowitz, NR-
dc.contributor.authorNukala, S-
dc.contributor.authorRosenberg, A-
dc.contributor.authorXu, J-
dc.contributor.authorStuchin, S-
dc.contributor.authorIorio, R-
dc.contributor.authorErrico, T-
dc.contributor.authorRadford, MJ-
dc.contributor.authorBerger, JS-
dc.date.accessioned2015-12-04T15:29:09Z-
dc.date.available2015-12-04T15:29:09Z-
dc.date.issued2015-
dc.identifier.citationThe American Journal of Cardiology, 2015, v. 115, p. 1643-1648-
dc.identifier.issn0002-9149-
dc.identifier.urihttp://hdl.handle.net/10722/221692-
dc.description.abstractMyocardial 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.-
dc.languageeng-
dc.publisherElsevier Inc. The Journal's web site is located at http://www.ajconline.org/-
dc.relation.ispartofThe American Journal of Cardiology-
dc.titleRelation of Perioperative Elevation of Troponin to Long-Term Mortality After Orthopedic Surgery-
dc.typeArticle-
dc.identifier.emailXu, J: xujf@hku.hk-
dc.identifier.authorityXu, J=rp02086-
dc.identifier.doi10.1016/j.amjcard.2015.03.003-
dc.identifier.pmid25890628-
dc.identifier.scopuseid_2-s2.0-84930177977-
dc.identifier.hkuros260480-
dc.identifier.volume115-
dc.identifier.spage1643-
dc.identifier.epage1648-
dc.identifier.isiWOS:000357702300003-

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