title: Detected troponin elevation is associated with high early mortality after lung resection for cancer.
abstract: BACKGROUND
  Myocardial infarction can be difficult to diagnose after lung surgery. As recent diagnostic criteria emphasize serum cardiac markers (in particular serum troponin) we set out to evaluate its clinical utility and to establish the long term prognostic impact of detected abnormal postoperative troponin levels after lung resection.
  
  
  METHODS
  We studied a historic cohort of patients with primary lung cancer who underwent intended surgical resection. Patients were grouped according to known postoperative troponin status and survival calculated by Kaplan Meier method and compared using log rank. Parametric survival analysis was used to ascertain independent predictors of mortality.
  
  
  RESULTS
  From 2001 to 2004, a total of 207 patients underwent lung resection for primary lung cancer of which 14 (7%) were identified with elevated serum troponin levels within 30 days of surgery, with 9 (64%) having classical features of myocardial infarction.The median time to follow up (interquartile range) was 22 (1 to 52) months, and the one and five year survival probabilities (95% CI) for patients without and with postoperative troponin elevation were 92% (85 to 96) versus 60% (31 to 80) and 61% (51 to 71) versus 18% (3 to 43) respectively (p < 0.001).T stage and postoperative troponin elevation remained independent predictors of mortality in the final multivariable model. The acceleration factor for death of elevated serum troponin after adjusting for tumour stage was 9.19 (95% CI 3.75 to 22.54).
  
  
  CONCLUSIONS
  Patients with detected serum troponin elevation are at high risk of early mortality with or without symptoms of myocardial infarction after lung resection.
authors.affiliation: Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, UK. eric.lim@cvsnet.org
authors.forename: Eric
authors.initials: E
authors.lastname: Lim
authors.forename: Li
authors.initials: L
authors.lastname: Li Choy
authors.forename: Lydia
authors.initials: L
authors.lastname: Flaks
authors.forename: Shafi
authors.initials: S
authors.lastname: Mussa
authors.forename: Fillip
authors.initials: F
authors.lastname: Van Tornout
authors.forename: Marc
authors.initials: M
authors.lastname: Van Leuven
authors.forename: G Wyn
authors.initials: GW
authors.lastname: Parry
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin