Related Experiment Video
Updated: May 14, 2026
A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats
Published on: December 2, 2016
Electrocardiograph changes, troponin levels and cardiac complications after orthopaedic surgery
Carol P Chong1, William J van Gaal, Konstantinos Profitis
1Department of Aged Care, The Northern Hospital, Epping, Victoria, Australia. carol.chong@nh.org.au
Insights
Postoperative troponin elevation, not electrocardiograph changes, is the best predictor of cardiac complications in elderly patients undergoing emergency orthopaedic surgery. Troponin levels correlate with ECG changes but do not always occur together.
Area of Science:
- Cardiology
- Orthopaedic Surgery
- Clinical Biochemistry
Background:
- The correlation between electrocardiograph (ECG) changes and troponin levels after emergency orthopaedic surgery is not well-defined.
- Troponin elevations are common postoperatively, often without concurrent ECG changes.
Purpose of the Study:
- To investigate the relationship between perioperative troponin elevations, ECG changes (ischemia or arrhythmia), and cardiac complications in elderly patients undergoing emergency orthopaedic surgery.
- To identify predictors of postoperative ECG changes and cardiac complications.
Main Methods:
- Prospective study of 187 orthopaedic patients over 60 years old.
- Monitoring of troponin I levels and ECGs on the first 3 postoperative mornings or until discharge.
- Analysis of pre- and postoperative troponin levels, ECG findings, and cardiac complications.
Main Results:
- Postoperative troponin elevation occurred in 37.4% of patients, mostly asymptomatic.
- Most troponin elevations (72.9%) were not associated with ECG changes.
- Postoperative troponin elevation (P = 0.018) and not preoperative troponin level (P = 0.060) was associated with ECG changes.
- Age and sex were predictors of postoperative ECG changes.
- Troponin elevation, pre- or postoperative, was a better predictor of cardiac complications than ECG changes.
Conclusions:
- Electrocardiograph changes are not always present with troponin elevations after emergency orthopaedic surgery.
- Higher troponin levels are associated with a greater likelihood of ECG changes.
- Postoperative troponin elevation is the strongest predictor of cardiac complications in this patient group.
Introduction:
The relationship between electrocardiograph (ECG) changes and troponin levels after the emergency orthopaedic surgery are not well characterised. The aim of this study was to determine the correlation between ECG changes (ischaemia or arrhythmia), troponin elevations perioperatively and cardiac complications.
Materials And Methods:
One hundred and eighty-seven orthopaedic patients over 60 years of age were prospectively tested for troponin I and ECGs were performed on the fi rst 3 postoperative mornings or until discharge.
Results:
The incidences of pre- and postoperative troponin elevation were 15.5% and 37.4% respectively, the majority were asymptomatically detected. Most of the patients who sustained a troponin rise did not have any concomitant ECG changes (51/70 or 72.9%). Postoperative ECG changes were noted in 18.4% (34/185) and of those with ECG changes, slightly more than half (55.9%) had a troponin elevation. Most ECG changes occurred on postoperative day 1 and were non-ST elevation in type. ECG changes occurred more frequently with higher troponin levels. Postoperative troponin elevation (P = 0.018) and not preoperative troponin level (P = 0.060) was associated with ECG changes on univariate analysis. Two premorbid factors were predictors of postoperative ECG changes using multivariate logistical regression; age [odds ratio (OR), 1.05; 95% CI, 1.005 to 1.100, P = 0.029) and sex OR, 2.4; 95% CI, 1.069 to 5.446, P = 0.034). Twenty patients sustained postoperative cardiac complications; 9 (45%) were associated with ECG changes and 16 (80%) with postoperative troponin elevation. Pre- or postoperative troponin elevation better predicted cardiac complications compared with preoperative ECG changes.
Conclusion:
Electrocardiograph changes do not necessarily accompany troponin elevations after the emergency orthopaedic surgery but are more likely to have higher troponin levels. The best predictor of postoperative cardiac complications is troponin elevation.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Cardiac Catheterization IV: Nursing Management
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
01:28Cardiac Catheterization I: Pre-Procedure Overview