Abstract
PurposePerioperative myocardial injury is a predictor of postoperative mortality, but the clinical impact of chronic injury during the perioperative period has not been fully investigated. This study aimed to evaluate chronic myocardial injury during the perioperative period in comparison with normal and acute myocardial injury.MethodsPatients with serial cardiac troponin measurements before and within 30 days following noncardiac surgery were divided into three groups: normal, acute injury, and chronic injury groups. Acute and chronic myocardial injuries were stratified according to 2018 recommendations by the International Federation of Clinical Chemistry and Laboratory Medicine’s Task Force on Clinical Applications of Bio-Markers. Thirty-day and one-year mortalities after surgery were compared.ResultsOf the 22,969 patients reviewed, 17,671 (76.9%) were classified into the normal, 5,179 (22.5%) into the acute injury, and 119 (0.5%) into the chronic injury groups. The acute and chronic injury groups had higher 30-day mortalities compared with the normal group (0.8% vs. 8.0%; hazard ratio [HR], 11.00; 95% confidence interval [CI], 9.05–13.37; P < 0.001 and 0.8% vs. 7.6%; HR, 10.55; 95% CI, 5.37–20.72; P < 0.001, respectively). In a direct comparison between the acute and chronic injury groups using an inverse probability of weighting adjustments, the 30-day and one-year mortalities were not significantly different.ConclusionChronic myocardial injury during the perioperative period may show similar clinical impacts on postoperative mortality compared with acute injury. Further studies are needed.
Highlights
Myocardial injury is defined as any elevation of cardiac troponin above the 99th percentile upper reference limit (URL) [1], and has shown significant associations with adverse outcomes [2]
Chronic myocardial injury during the perioperative period may show similar clinical impacts on postoperative mortality compared with acute injury
A recent study demonstrated that an increase in absolute cardiac troponin (cTn) value over the 99th percentile URL during the perioperative period was associated with mortality [9], but the differentiation between acute and chronic conditions still remains challenging [10]
Summary
Myocardial injury is defined as any elevation of cardiac troponin (cTn) above the 99th percentile upper reference limit (URL) [1], and has shown significant associations with adverse outcomes [2]. In surgical patients, this association was consistent [3], but the differential diagnoses for elevated cTn can be broad. A recent study demonstrated that an increase in absolute cTn value over the 99th percentile URL during the perioperative period was associated with mortality [9], but the differentiation between acute and chronic conditions still remains challenging [10]. Chronic myocardial injury conditions in surgical patients have been hard to investigate
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