Does elevated postoperative troponin I predict major cardiac events in patients undergoing hip surgery?
Troponin I elevation after hip surgery is common and strongly predicts long-term major cardiac events and mortality, highlighting the importance of perioperative cardiac monitoring.
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%).
Ausset et al. (2007) studied this question.