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Impact of troponin 1 on long‐term mortality after emergency orthopaedic surgery in older patients
Author(s) -
Chong C.,
Lam Q.,
Ryan J.,
Sinnappu R.,
Lim W. K.
Publication year - 2010
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2009.02063.x
Subject(s) - medicine , troponin , odds ratio , confidence interval , asymptomatic , cardiology , troponin t , troponin i , atrial fibrillation , surgery , myocardial infarction
Objectives: To determine the association between post‐operative troponin rises and longer term (2‐year) mortality after emergency orthopaedic surgery in patients over 60 years of age. Methods: One hundred and two patients were recruited in 2006 and had inpatient troponin 1 measurements. These patients were followed up by a telephone call annually for complications. Results: At 2 years, 29.4% (30/102) of patients had died. Twenty‐five patients (25/54 or 49.3%) with a troponin rise were dead at 2 years compared with five patients without a troponin rise (5/48 or 10.4%), which was significantly different P < 0.0001. Patients with a higher troponin level (>0.1 µg/L) were more likely to be dead at 2 years compared with those with a lower level of troponin. However, when adjusted for other comorbidities the association between troponin elevation and death at 2 years did not persist. Using Cox regression multivariate analysis, only one factor, sustaining an in‐hospital cardiac event odds ratio 4.3 (95% confidence interval 1.8–10.3, P = 0.001), was associated with 2 years all‐cause mortality . Furthermore, patients who sustained a symptomatic troponin rise ( P < 0.0001) or asymptomatic troponin rise ( P = 0.004) were more likely to have died at 2 years compared with those with no troponin rise. Three factors were significantly associated with a cardiac event during the second year: (i) post‐operative troponin rise ( P = 0.05); (ii) pre‐morbid atrial fibrillation ( P = 0.04); and (iii) post‐operative renal failure ( P < 0.001). Conclusion: Elevated post‐operative troponin levels are predictive of 1‐year but not 2‐year mortality in older patients undergoing emergency orthopaedic surgery.