Myocardial necrosis in the perioperative period of noncardiac surgery is associated
with short-term mortality, but long-term outcomes have not been characterized. We
investigated the association between perioperative troponin elevation and long-term
mortality in a retrospective study of consecutive subjects who underwent hip, knee,
and spine surgery. Perioperative myocardial necrosis and International Classification of Disease, Ninth Revision–coded myocardial infarction (MI) were recorded. Long-term survival was assessed using
the Social Security Death Index database. Logistic regression models were used to
identify independent predictors of long-term mortality. A total of 3,050 subjects
underwent surgery. Mean age was 60.8 years, and 59% were women. Postoperative troponin
was measured in 1,055 subjects (34.6%). Myocardial necrosis occurred in 179 cases
(5.9%), and MI was coded in 20 (0.7%). Over 9,015 patient-years of follow-up, 111
deaths (3.6%) occurred. Long-term mortality was 16.8% in subjects with myocardial
necrosis and 5.8% with a troponin in the normal range. Perioperative troponin elevation
(hazard ratio 2.33, 95% confidence interval 1.33 to 4.10) and coded postoperative
MI (adjusted hazard ratio 3.51, 95% confidence interval 1.44 to 8.53) were significantly
associated with long-term mortality after multivariable adjustment. After excluding
patients with coronary artery disease and renal dysfunction, myocardial necrosis remained
associated with long-term mortality. In conclusion, postoperative myocardial necrosis
is common after orthopedic surgery. Myocardial necrosis is independently associated
with long-term mortality at 3 years and may be used to identify patients at higher
risk for events who may benefit from aggressive management of cardiovascular risk
factors.
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Article Info
Publication History
Published online: March 24, 2015
Accepted:
March 13,
2015
Received in revised form:
March 13,
2015
Received:
January 30,
2015
Footnotes
Drs. Oberweis and Smilowitz contributed equally to this study.
See page 1647 for disclosure information.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
