Myocardial injury after lung cancer surgery as a predictor of postoperative long-term mortality: A prospective cohort study

Introduction: Myocardial injury after non-cardiac surgery (MINS), characterized by cardiac troponin (cTn) elevation, is a marker of poor postoperative prognosis. The predictive value of MINS in thoracic oncosurgery remains unclear. The aim of the study was to determine the prognostic value of acute myocardial injury after surgical lung resection for 1-year all-cause mortality in patients with non-small-cell lung cancer (NSCLC). Methods: In this prospective cohort study, 101 consecutive men aged 63.0 (58;67) years who underwent surgical lung resection for NSCLC, were enrolled. Serum cTnI concentration was measured preoperatively and in 24 and 48 hours postoperatively. MINS was defined by at least one postoperative cTnI value that exceeds the 99th percentile upper reference limit, as a result of a presumed ischemic mechanism. The primary endpoint was 1-year all-cause mortality. Results: MINS was diagnosed in 37 patients (36.6%). During the follow-up, three patients were lost, and 28 (27.7%) died. Multivariate Cox regression analysis identified MINS as an independent predictor of all-cause mortality (adjusted hazard ratio HR 2.98, 95% confidence interval CI 1.29–6.89, P=0.011). The prognostic significance was also revealed for preoperative N-terminal prohormone of brain natriuretic peptide (HR 1.18, 95% CI 1.03–1.34, P=0.014), advanced cancer stage (HR 3.21, 95% CI 1.28–8.04, P=0.013), adjuvant chemotherapy (HR 0.22, 95% CI 0.08–0.57, P=0.002), and aspirin use (HR 0.09, 95% CI 0.01–0.72, P=0.024). Conclusion: Myocardial injury within the first 72 hours after surgical lung resection was found as an independent predictor of 1-year all-cause mortality in patients with NSCLC.