Noncardiac surgery

Numerous studies have now confirmed the successful role of monitoring either cTnl or cTnT after noncardiac surgery to detect perioperative MI (46-50). In a study of 96 patients undergoing vascular surgery, serial measurements of cTnl confirmed 8 patients who had new cardiac abnormalities detected during echocardiography (46). Measurement of cTnl differentiated the high incidence (19%) of false-positive increases in CK-MB associated with skeletal muscle release of CK-MB (46). More important, postoperative increases in cTnl and cTnT are associated with an increased risk of short-term mortality after vascular surgery (Fig. 8) (48) as well as nonvascular procedures. Although abnormal results of troponin testing are more frequent in patients undergoing vascular surgery, the incidence of detectable myocardial injury appears similar between nonvascular and vascular surgery after adjusting for the presence of concomitant CAD.

Fig. 7. Kaplan-Meier survival curves for 181 patients with acute stroke stratified by normal and increased cTnT concentrations. (Reproduced from ref. 43.)

Weeks after Surgery

Fig. 8. Kaplan-Meier survival curves in 229 postoperative vascular surgery patients based on cTnI levels. CI, confidence interval; HR, hazard ratio. (Reproduced from ref. 48.)

Weeks after Surgery

Fig. 8. Kaplan-Meier survival curves in 229 postoperative vascular surgery patients based on cTnI levels. CI, confidence interval; HR, hazard ratio. (Reproduced from ref. 48.)

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