Incidence of post-operative troponin I rises and 1-year mortality after emergency orthopaedic surgery in older patients
Incidence of post-operative troponin I rises and 1-year mortality after emergency orthopaedic surgery in older patients
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DOI：
10.1093/ageing/afn231
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发表时间：
2009-03-01
期刊：
影响因子：
6.7
通讯作者：
Lim, Wen Kwang
中科院分区：
文献类型：
--
作者：
Chong, Carol P.;Lam, Que T.;Lim, Wen Kwang
目的：确定术后肌钙蛋白I升高的发生率及其与急诊骨科老年外科手术后1年全因死亡率和心脏事件的相关性，这在以前没有研究过。结果：术后肌钙蛋白升高的发生率为52.9%。术后急性心肌梗死的诊断率为9.8%，1年时，70%的患者死亡。1年时，32.4%（33/102）的患者发生持续性心脏事件（心肌梗死、充血性心力衰竭、房颤或严重心律失常），使用多变量分析，术后肌钙蛋白升高（OR 3.9，95% CI 1.4-10.7，P = 0.008）是其独立预测因素。肌钙蛋白升高的患者中有一半发生心脏事件，而没有升高的患者中有18.8%发生心脏事件。1年时全因死亡率为20.6%; 37%的患者术后肌钙蛋白升高，而2.1%的患者术后肌钙蛋白未升高（P < 0.0001）。使用多变量分析，只有两个因素与1年全因死亡率相关：术后肌钙蛋白升高（OR 12. 0，95% CI 1. 4 - 104. 8，P = 0. 025）和持续的术后院内心脏事件（OR 6. 6，95% CI 1. 7 - 25. 6，P = 0. 006）。此外，肌钙蛋白水平较高的患者有显着较差的survival.Conclusions：有一个高发病率的术后肌钙蛋白I上升的老年患者接受急诊骨科手术，1年死亡率和心脏事件显着增加，这些患者。未来的研究需要确定是否有任何干预措施可以改善这些患者的预后。
Objectives: to determine the incidence of post-operative troponin I rises and its association with 1-year all-cause mortality and cardiac events after emergency orthopaedic-geriatric surgery, which has not been studied before.Methods: one hundred and two patients over the age of 60 were recruited and followed up at 1 year. All consented to serial troponin I measurements peri-operatively.Results: the incidence of a troponin I rise post-operatively was 52.9%. Post-operative acute myocardial infarction was diagnosed in 9.8% and at 1 year, 70% of these patients were dead. At 1 year, 32.4% (33/102) had sustained a cardiac event (myocardial infarction, congestive cardiac failure, atrial fibrillation or major arrhythmia) and using multivariate analysis, post-operative troponin rise (OR 3.9, 95% CI 1.4-10.7, P = 0.008) was an independent predictor of this. Half of the patients with a troponin rise had a cardiac event compared to 18.8% without a rise. All-cause mortality was 20.6% at 1 year; 37% with an associated post-operative troponin rise died versus 2.1% without a rise (P < 0.0001). Using multivariate analysis, only two factors were associated with 1-year all-cause mortality: post-operative troponin rise (OR 12.0, 95% CI 1.4-104.8, P = 0.025) and sustaining a post-operative in-hospital cardiac event (OR 6.6, 95% CI 1.7-25.6, P = 0.006). Furthermore, patients with higher troponin levels had significantly worse survival.Conclusions: there is a high incidence of post-operative troponin I rises in older patients undergoing emergency orthopaedic surgery with 1-year mortality and cardiac events being significantly increased in these patients. Future studies are needed to determine whether any intervention can improve outcome for these patients.