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Cardiac troponin I release after hip surgery correlates with poor long-term cardiac outcome

Published online by Cambridge University Press:  01 February 2008

S. Ausset ,
Y. Auroy ,
E. Lambert ,
P. Vest ,
C. Plotton ,
S. Rigal ,
B. Lenoir  and
D. Benhamou
S. Ausset*
Affiliation:
Hôpital d’Instruction des Armées Percy, Service d’Anesthésie-Réanimation, Clamart Cedex, France
Y. Auroy
Affiliation:
Hôpital d’Instruction des Armées Percy, Service d’Anesthésie-Réanimation, Clamart Cedex, France
E. Lambert
Affiliation:
Hôpital d’Instruction des Armées Percy, Service d’Anesthésie-Réanimation, Clamart Cedex, France
P. Vest
Affiliation:
Hôpital d’Instruction des Armées Percy, Service de Biochimie, Clamart Cedex, France
C. Plotton
Affiliation:
Hôpital d’Instruction des Armées Percy, Service de Cardiologie, Clamart Cedex, France
S. Rigal
Affiliation:
Hôpital d’Instruction des Armées Percy, Service de Chirurgie Orthopédique, Clamart Cedex, France
B. Lenoir
Affiliation:
Hôpital d’Instruction des Armées Percy, Service d’Anesthésie-Réanimation, Clamart Cedex, France
D. Benhamou
Affiliation:
Bicêtre University Hospital, Département d’Anesthésie-Réanimation, Le Kremlin Bicêtre Cedex, France
*
Correspondence to: Sylvain Ausset, Service d’Anesthésie-Réanimation, Hôpital d’Instruction des Armées Percy, 101, Avenue Henri Barbusse, BP 406, 92141 Clamart Cedex, France. E-mail: sylvain.ausset@gmail.com; Tel: +33 1 41 46 64 40; Fax: +33 1 41 46 64 60
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Summary

Background and objective

The aim of this study was to assess the incidence of perioperative myocardial damage detected by serial measurements of troponin I after hip surgery and its association with late cardiovascular outcome.

Methods

Troponin I was measured during the first three postoperative days in 88 consecutive patients undergoing hip surgery. Values above the 99th percentile (0.08 ng mL−1) were considered positive. Major cardiac events (cardiac death, myocardial infarction and cardiac failure) were recorded during hospital stay and 1 yr after surgery.

Results

Eleven patients (12.5%) exhibited elevated troponin I levels during hospital stay. Nine of them remained asymptomatic. During follow-up, 45% of them (5/11) suffered from a major cardiac event vs. 4% (3/76) for patients with normal postoperative troponin I levels (P = 0.0006). All-cause mortality rate was 36% (4/11) at 1 yr vs. 7% (5/71, P = 0.0131). Using multivariate Cox regression analysis adjusted for baseline data, independent factors associated with the occurrence of a cardiac event were troponin I elevation (OR=17.4 – CI 95% 3.7–82) and age (OR=1.1 yr−1 – CI 95% 1.01–1.21). Independent factors for all-cause mortality were troponin I elevation (OR=41.4 – CI 95% 5.4–320.4), and age (OR=1.3 yr−1 – CI 95% 1.1–1.4).

Conclusion

Troponin I release is common after hip surgery and is associated with a 10-fold increased incidence of long-term major cardiac events as compared to patients with normal troponin I levels (45% vs. 4%).

Keywords

HEARTISCHAEMIATROPONIN ISURGERY, hipORTHOPAEDICSTREATMENT OUTCOME
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 2 , February 2008 , pp. 158 - 164
Copyright
Copyright © European Society of Anaesthesiology 2007

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