title: Incidence and significance of myocardial injury after surgical treatment of head and neck cancer.
abstract: OBJECTIVE
  To review the incidence of, and risk factors for myocardial injury after head and neck surgery to help optimize patient care and develop perioperative cardioprotective strategies.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Records of 65 patients surgically treated for upper aerodigestive tract squamous cell carcinoma between 2005 and 2006 were reviewed. Information about cardiovascular history, tumor characteristics, details of surgery, and postoperative complications were recorded. Patients had troponin assays on the third postoperative day. Logistic regression was used to identify risk factors for postoperative myocardial injury.
  
  
  RESULTS
  The average age at presentation was 62+/-12 years. There were 46 (71%) males and 19 (29%) females. Troponin-positive and -negative groups were matched for age, sex, cardiovascular risks, comorbidity, site, tumor-node-metastasis status, and duration of the operations. Sixteen (25%) patients had postoperative myocardial injury including five clinical myocardial infarctions. Factors identified as independent predictors of postoperative myocardial injury were blood pressure level (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.04-1.31; P<.02), intraoperative heart rate variability (OR 1.33; 95% CI 1.04-1.71; P<.02), and the degree of postoperative inflammatory response (OR 1.07; 95% CI 1.02-1.13; P<.001).
  
  
  CONCLUSIONS
  Postoperative myocardial injury is a known independent predictor of cardiovascular prognosis. Its incidence in head and neck patients could potentially be reduced through stringent blood pressure management, tight intraoperative heart rate control, and dampening of the postoperative inflammatory response. Troponin testing is a valuable screening tool, and patients who have elevated levels postoperatively should be closely monitored and referred to a cardiologist for optimization of cardiovascular care.
authors.affiliation: Department of Otolaryngology, Charing Cross Hospital, London, and Department of Physiology, Development and Neuroscience, Cambridge University, UK. RN@cantab.net
authors.forename: S A Reza
authors.initials: SA
authors.lastname: Nouraei
authors.forename: Chadwan
authors.initials: C
authors.lastname: Al-Yaghchi
authors.forename: Guri S
authors.initials: GS
authors.lastname: Sandhu
authors.forename: Dino A
authors.initials: DA
authors.lastname: Giussani
authors.forename: Patrick
authors.initials: P
authors.lastname: Doyle
authors.forename: Peter M
authors.initials: PM
authors.lastname: Clarke
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D037981:Neck Dissection; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin; D002097:C-Reactive Protein