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Incidence and Significance of Myocardial Injury After Surgical Treatment of Head and Neck Cancer
Author(s) -
Nouraei S. A. Reza,
AlYaghchi Chadwan,
Sandhu Guri S.,
Giussani Dino A.,
Doyle Patrick,
Clarke Peter M.
Publication year - 2007
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/mlg.0b013e3180ca7863
Subject(s) - medicine , perioperative , troponin , odds ratio , head and neck cancer , incidence (geometry) , confidence interval , myocardial infarction , head and neck squamous cell carcinoma , blood pressure , troponin i , cancer , cardiology , surgery , physics , optics
Objective/Hypothesis: To review the incidence of, and risk factors for myocardial injury after head and neck surgery to help optimize patient care and develop perioperative cardioprotective strategies. Study Design: Observational cohort study. Methods: Records of 65 patients surgically treated for upper aerodigestive tract squamous cell carcinoma between 2005 and 2006 were reviewed. Information about cardiovascular history, tumor characteristics, details of surgery, and postoperative complications were recorded. Patients had troponin assays on the third postoperative day. Logistic regression was used to identify risk factors for postoperative myocardial injury. Results: The average age at presentation was 62 ± 12 years. There were 46 (71%) males and 19 (29%) females. Troponin‐positive and ‐negative groups were matched for age, sex, cardiovascular risks, comorbidity, site, tumor‐node‐metastasis status, and duration of the operations. Sixteen (25%) patients had postoperative myocardial injury including five clinical myocardial infarctions. Factors identified as independent predictors of postoperative myocardial injury were blood pressure level (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.04–1.31; P < .02), intraoperative heart rate variability (OR 1.33; 95% CI 1.04–1.71; P < .02), and the degree of postoperative inflammatory response (OR 1.07; 95% CI 1.02–1.13; P < .001). Conclusions: Postoperative myocardial injury is a known independent predictor of cardiovascular prognosis. Its incidence in head and neck patients could potentially be reduced through stringent blood pressure management, tight intraoperative heart rate control, and dampening of the postoperative inflammatory response. Troponin testing is a valuable screening tool, and patients who have elevated levels postoperatively should be closely monitored and referred to a cardiologist for optimization of cardiovascular care.