Related Experiment Video
Updated: Aug 24, 2025
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Predicting Postoperative Troponin in Patients Undergoing Elective Hip or Knee Arthroplasty: A Comparison of Five
Merih T Tesfazghi1,2, Anne R Bass3, Noor Al-Hammadi4
1Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO, USA.
Insights
Cardiac risk scores modestly predicted myocardial injury after noncardiac surgery (MINS) in men undergoing hip or knee arthroplasty. Baseline high-sensitivity cardiac troponin I (hs-cTnI) effectively predicted MINS in both sexes.
Area of Science:
- Cardiology
- Orthopedic Surgery
- Geriatric Medicine
Background:
- Elderly patients undergoing hip or knee arthroplasty face risks of myocardial injury after noncardiac surgery (MINS).
- Assessing cardiac risk is crucial for optimizing patient outcomes in this demographic.
Purpose of the Study:
- To evaluate the predictive ability of five common cardiac risk scores for MINS.
- To assess the correlation of these scores with postoperative hs-cTnI levels.
- To determine the utility of baseline hs-cTnI in predicting MINS.
Main Methods:
- Ancillary study to the GIFT trial involving patients aged 65+ undergoing elective hip or knee arthroplasty.
- Evaluation of ASCVD, FRS, ACS-NSQIP, RCRI, and R-RCRI risk scores.
- Analysis of baseline and postoperative day 2 (POD2) hs-cTnI levels.
Main Results:
- No cardiac risk scores predicted MINS in women.
- ASCVD, ACS-NSQIP, and RCRI scores predicted MINS in men.
- All risk scores correlated with POD2 hs-cTnI levels.
- Baseline hs-cTnI predicted MINS in both women (C-statistic 0.63) and men (C-statistic 0.72).
Conclusions:
- Cardiac risk scores showed modest predictive value for MINS in men undergoing arthroplasty.
- Baseline hs-cTnI is a significant predictor of MINS in this patient population.
- Risk stratification for MINS may benefit from incorporating hs-cTnI levels.
Background:
Elderly patients undergoing hip or knee arthroplasty are at a risk for myocardial injury after noncardiac surgery (MINS). We evaluated the ability of five common cardiac risk scores, alone or combined with baseline high-sensitivity cardiac troponin I (hs-cTnI), in predicting MINS and postoperative day 2 (POD2) hs-cTnI levels in patients undergoing elective total hip or knee arthroplasty.
Methods:
This study is ancillary to the Genetics-InFormatics Trial (GIFT) of Warfarin Therapy to Prevent Deep Venous Thrombosis, which enrolled patients 65 years and older undergoing elective total hip or knee arthroplasty. The five cardiac risk scores evaluated were the atherosclerotic cardiovascular disease calculator (ASCVD), the Framingham risk score (FRS), the American College of Surgeon's National Surgical Quality Improvement Program (ACS-NSQIP) calculator, the revised cardiac risk index (RCRI), and the reconstructed RCRI (R-RCRI).
Results:
None of the scores predicted MINS in women. Among men, the ASCVD (C-statistic of 0.66; p=0.04), ACS-NSQIP (C-statistic of 0.69; p=0.01), and RCRI (C-statistic of 0.64; p=0.04) predicted MINS. Among all patients, spearman correlations (r s) of the risk scores with the POD2 hs-cTnI levels were 0.24, 0.20, 0.11, 0.11, and 0.08 for the ASCVD, Framingham, ACS-NSQIP, RCRI, and R-RCRI scores, respectively, with p values of <0.001, <0.001, <0.001, 0.006, and 0.025. Baseline hs-cTnI predicted MINS (C-statistics: 0.63 in women and 0.72 in men) and postoperative hs-cTnI (r s = 0.51, p=0.001).
Conclusion:
In elderly patients undergoing elective hip or knee arthroplasty, several of the scores modestly predicted MINS in men and correlated with POD2 hs-cTnI.
More Related Videos
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...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT