Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease.
OBJECTIVE
The aim of this study was to determine whether perioperative measurements of heart rate variability (HRV) and cardiac troponin I (cTnI) add additional prognostic information to established risk scores for first-year mortality in patients at risk of coronary artery disease (CAD) undergoing major noncardiac surgery.


BACKGROUND
In cardiac-risk patients undergoing major noncardiac surgery, the short- and long-term prognoses are mainly influenced by perioperative cardiac complications. Heart rate variability and cTnI are important prognostic markers in patients with congestive heart failure and myocardial infarction.


METHODS
In a prospective study, 173 patients with CAD or at high risk of CAD undergoing major noncardiac surgery were followed up for one year. The main outcome measure was all-cause mortality. In addition to clinical parameters and established risk scores, HRV and cTnI were assessed perioperatively.


RESULTS
Twenty-eight (16%) patients died within one year. Multivariate logistic regression analysis revealed three findings that were independently associated with death within the first year after surgery: the revised cardiac risk index (odds ratio 6.2 [95% confidence interval 1.6 to 25], depressed HRV before induction of anesthesia (16.2 [2.8 to 94]), and elevation of cTnI on postoperative day 1 or 2 (9.8 [3.0 to 32]).


CONCLUSIONS
Depressed HRV before induction of anesthesia and elevated cTnI postoperatively are independent and powerful predictors of one-year mortality for patients at risk of CAD undergoing major noncardiac surgery and add incremental prognostic information to established risk scores that only consider preoperative information.
Filipovic
Miodrag
M
Department of Anesthesia, University of Basel/Kantonsspital, Switzerland. mfilopvic@uhbs.ch
Jeger
Raban
R
Probst
Cecilia
C
Girard
Thierry
T
Pfisterer
Matthias
M
Gürke
Lorenz
L
Skarvan
Karl
K
Seeberger
Manfred D
MD
D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006321:Heart / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000401:mortality*; D016019:Survival Analysis; D019210:Troponin I / Q000032:analysis / Q000502:physiology*
D019210:Troponin I