Key result
Preoperative myocardial injury significantly increased 30-day mortality after non-cardiac surgery compared to normal troponin levels (10.7% vs 1.4%; HR 3.12), similar to postoperative injury.
Why the study?
Although pre- and postoperative myocardial injuries are associated with increased postoperative mortality, no study had directly compared their effects on 30-day mortality after non-cardiac surgery.
Does preoperative or postoperative myocardial injury increase postoperative 30-day mortality in patients undergoing non-cardiac surgery?
Cohort (n=4,612)
No
Does preoperative or postoperative myocardial injury increase postoperative 30-day mortality in patients undergoing non-cardiac surgery?
Hazard Ratio: 3.12 (95% CI 1.62–6.01)
Absolute Event Rate: 10.7% vs 1.4%
p-value: p=0.001
Preoperative myocardial injury is associated with a similar increase in 30-day mortality as postoperative myocardial injury after non-cardiac surgery, highlighting the prognostic importance of preoperative troponin screening.
Preoperative troponin elevation was associated with higher 30-day mortality after non-cardiac surgery; leaves open whether routine preoperative screening improves outcomes.
Abstract Background: Although both pre- and postoperative myocardial injuries are strongly associated with an increased postoperative mortality, no study has directly compared the effects of pre- and postoperative myocardial injuries on 30-day mortality after non-cardiac surgery. Therefore, we evaluated and compared the effects of pre- and postoperative myocardial injury on 30-day mortality after non-cardiac surgery.Methods: From January 2010 to December 2016, patients undergoing non-cardiac surgery were stratified into either the normal (n = 3,182), preoperative myocardial injury (n = 694), or postoperative myocardial injury (n = 756) groups. Myocardial injury was defined as a sole elevation of cardiac troponin value above the 99th percentile upper reference limit without ischemic symptom using the 4th universal definition of myocardial infarction. Patients in the preoperative myocardial injury group were further divided into the attenuated (n = 177) or persistent myocardial injury group (n = 517) according to the changes in postoperative cardiac troponin level. As the primary outcome, postoperative 30-day mortalities were compared among the groups using the weighted Cox proportional-hazards regression models with the inverse probability weighting.Results: Compared with the normal group, postoperative 30-day mortality was increased significantly both in the pre- and postoperative myocardial injury groups (1.4% vs. 10.7%; hazard ratio [HR] 3.12; 95% confidence interval [CI] 1.62-6.01; p = 0.001 and 1.4% vs. 7.4%; HR 4.49; 95% CI 2.34-8.60; p < 0.001, respectively), however, there was no difference between the pre- and postoperative myocardial injury groups (HR, 1.44; 95% CI 0.79–2.64; p = 0.45). In addition, the attenuated myocardial injury group showed a significantly lower postoperative 30-day mortality than the persistent myocardial injury group (5.6% vs. 12.4%; HR 2.23; 95% CI 1.17–4.44; p = 0.02).Conclusion: In patients undergoing non-cardiac surgery, preoperative myocardial injury also increased postoperative 30-day mortality to a similar degree of postoperative myocardial injury. In addition, attenuation of preoperative myocardial injury might decrease in 30-day mortality after non-cardiac surgery.
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Lee et al. (2019) conducted a cohort in Non-cardiac surgery (n=4,612). Preoperative myocardial injury vs. Normal cardiac troponin levels was evaluated on 30-day mortality (HR 3.12, 95% CI 1.62-6.01, p=0.001). Preoperative myocardial injury significantly increased 30-day mortality after non-cardiac surgery compared to normal troponin levels (10.7% vs 1.4%; HR 3.12), similar to postoperative injury.
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