Cardiac troponin I release after hip surgery correlates with poor long-term cardiac outcome.
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).


CONCLUSIONS
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
S
S
Hôpital d'Instruction des Armées Percy, Service d'Anesthésie-Réanimation, Clamart Cedex, France. sylvain.ausset@gmail.com
Auroy
Y
Y
Lambert
E
E
Vest
P
P
Plotton
C
C
Rigal
S
S
Lenoir
B
B
Benhamou
D
D
D000368:Aged; D000758:Anesthesia / Q000379:methods; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000097:blood* / Q000209:etiology; D006615:Hip / Q000601:surgery*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood; D009206:Myocardium / Q000378:metabolism*; D011183:Postoperative Complications / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013995:Time; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I