title: Troponin T-values provide long-term prognosis in elderly patients undergoing non-cardiac surgery.
abstract: BACKGROUND
  The aim of this study was to evaluate the significance of elevated postoperative Troponin T (TnT) levels in an elderly population undergoing non-cardiac surgery.
  
  
  METHODS
  Five hundred and forty-six consecutive patients aged 70 years or older undergoing non-cardiac surgery of >30-min duration were enrolled in this prospective, observational study. A postoperative TnT measurement was obtained on the 5th to 7th postoperative day. Troponin T values greater than 0.02 ng ml(-1) were considered positive. Patients were followed over a 1-year period, and mortality and non-fatal cardiac events (acute myocardial infarction and coronary interventions) were recorded.
  
  
  RESULTS
  Troponin T concentrations greater than 0.02 ng ml(-1) were detected in 53 of the study subjects (9.7%). Eleven per cent of the patients with elevated TnT had electrocardiographic or clinical signs of myocardial ischemia. One year after surgery, 17 (32%) of the patients with abnormal TnT concentrations had died. In a multivariate Cox regression analysis adjusting for baseline and perioperative data, a TnT value >0.02 ng ml(-1) was an independent correlate of the mortality adjusted hazard ratio (HR): 14.9 (95% CI 3.7-60.3). Other independent predictors of death were tachycardia (HR, 14.9 95% CI 3.45-64.8), ASA 4 (HR, 8.1 95% CI 1.3-50.0), reoperation (HR, 6.4 95% CI 1.1-36.9), and use of diuretics (HR, 4.2 95% CI 1.3-13.8).
  
  
  CONCLUSIONS
  We conclude that elevated TnT levels in the postoperative period confer a 15-fold increase in mortality during the first year after surgery. Our findings also provide evidence that silent myocardial ischemia is common in an elderly population. Routine perioperative surveillance for TnT might therefore be of use in detecting patients at an increased risk of mortality during the first postoperative year.
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital, Linkoping, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Oscarsson
authors.forename: C
authors.initials: C
authors.lastname: Eintrei
authors.forename: S
authors.initials: S
authors.lastname: Anskär
authors.forename: O
authors.initials: O
authors.lastname: Engdahl
authors.forename: L
authors.initials: L
authors.lastname: Fagerström
authors.forename: P
authors.initials: P
authors.lastname: Blomqvist
authors.forename: M
authors.initials: M
authors.lastname: Fredriksson
authors.forename: E
authors.initials: E
authors.lastname: Swahn
mesh_terms: D000368:Aged; D000758:Anesthesia; D002423:Cause of Death; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T