title: 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.
abstract: 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.
authors.affiliation: Department of Anesthesia, University of Basel/Kantonsspital, Switzerland. mfilopvic@uhbs.ch
authors.forename: Miodrag
authors.initials: M
authors.lastname: Filipovic
authors.forename: Raban
authors.initials: R
authors.lastname: Jeger
authors.forename: Cecilia
authors.initials: C
authors.lastname: Probst
authors.forename: Thierry
authors.initials: T
authors.lastname: Girard
authors.forename: Matthias
authors.initials: M
authors.lastname: Pfisterer
authors.forename: Lorenz
authors.initials: L
authors.lastname: Gürke
authors.forename: Karl
authors.initials: K
authors.lastname: Skarvan
authors.forename: Manfred D
authors.initials: MD
authors.lastname: Seeberger
mesh_terms: 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*
chemical_list: D019210:Troponin I