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Prognostic value of perioperative high sensitivity troponin in patients undergoing hip and knee arthroplasty
Fábio de Souza1, Kelly Biancardini Gomes Barbato2, Viviani Barreira Marangoni Ferreira3
1Department of Internal Medicine, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil; Cardiology Discipline, Departamento de Medicina Especializada (DEMESP), Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
Insights
Perioperative Myocardial Injury (PMI), identified by high-sensitivity Troponin I (hs-TnI) levels, significantly increases mortality risk after orthopedic surgery. Patients with PMI face worse short- and long-term prognoses, highlighting the importance of monitoring cardiac events.
Area of Science:
- Cardiology
- Orthopedic Surgery
- Biomarkers
Background:
- Orthopedic surgeries like Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) carry risks.
- Perioperative Myocardial Injury (PMI) is a potential complication.
- High-sensitivity Troponin I (hs-TnI) is a key biomarker for cardiac injury.
Purpose of the Study:
- To investigate the prognostic value of hs-TnI in detecting Perioperative Myocardial Injury (PMI).
- To assess the short- and long-term outcomes associated with PMI after major orthopedic surgery.
- To evaluate the association between PMI and all-cause mortality and a composite adverse cardiovascular outcome.
Main Methods:
- A prospective observational study was conducted in a tertiary orthopedic center.
- Perioperative Myocardial Injury (PMI) was defined as an absolute increase in hs-TnI of ≥ 26 ng/L above preoperative values.
- Outcomes included all-cause mortality at 30 days and 18 months, and a composite of cardiovascular death, myocardial infarction, angina, or stroke. Cox proportional hazards models were used for long-term analysis.
Main Results:
- PMI occurred in 3.4% of surgeries.
- At 30 days, 6.6% of patients with PMI died versus none without PMI.
- At 18 months, 20.0% of patients with PMI died compared to 4.7% without PMI (RR=5.0).
- PMI was associated with significantly higher risks for both all-cause mortality (HR=3.97) and composite outcomes (HR=5.80) at 18 months.
- Patients with PMI undergoing THA or TKA had worse prognoses.
Conclusions:
- Perioperative Myocardial Injury (PMI) detected by hs-TnI is associated with significantly worse short- and long-term prognoses after orthopedic surgery.
- PMI is a strong predictor of increased all-cause mortality and adverse cardiovascular events following THA and TKA.
- Monitoring hs-TnI levels is crucial for risk stratification and management of patients undergoing major orthopedic procedures.
Abstract:
The authors conducted a prospective observational study to investigate the prognostic value of high-sensitivity Troponin I (hs-TnI) in the short- and long-term periods after orthopedic surgery, including Total Hip and Knee Arthroplasty (THA and TKA, respectively), in a tertiary orthopedic center in Brazil. Perioperative Myocardial Injury (PMI) was defined as an absolute increase in hs-TnI of ≥ 26 ng/L above preoperative values. The primary endpoint was all-cause mortality assessed at 30 days and 18 months after surgery. The secondary endpoint consisted of a composite outcome: cardiovascular death, acute myocardial infarction, angina requiring revascularization, and/or stroke. The authors compared Relative Risks (RR) of all-cause mortality and composite outcomes in patients with or without PMI at 30 days and 18 months. A Cox proportional hazards model for long-term outcomes was calculated and adjusted for age > 70 years, gender, and Revised Cardiac Risk Index (RCRI) class ≥ 2. PMI occurred in 3.4 % of all surgeries. At 30-days, 6.6 % of patients with PMI had died versus none without PMI. At 18 months, 20.0 % of PMI versus 4.7 % without PMI had died (RR = 5.0; 95 % Confidence Interval [95 % CI 1.3-19.3]). Based on composite outcomes in short and long-term periods, the RRs were 16.2 (95 % CI 2.7-96.5) and 7.7 (95 % CI 2.2-26.6), respectively. PMI was associated with all-cause mortality after 18 months and increased risk for a composite outcome (Hazard Ratio [HR = 3.97], 95 % CI 1.13-13.89 and HR = 5.80, 95 % CI 1.93-17.45, respectively). Patients with PMI who underwent THA or TKA presented worse short- and long-term prognoses compared to those without PMI.
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