Electrocardiograph changes, troponin levels and cardiac complications after orthopaedic surgery

• Published in: Annals of the Academy of Medicine, Singapore Vol. 42; no. 1; pp. 24 - 32
• Main Authors: Chong, Carol P, van Gaal, William J, Profitis, Konstantinos, Ryan, Julie E, Savige, Judy, Lim, Wen Kwang
• Format: Journal Article
• Language: English
• Published: Singapore 01.01.2013
• Subjects: Aged; Aged, 80 and over; Arrhythmias, Cardiac - blood; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - mortality; Biomarkers - blood; Electrocardiography; Female; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Ischemia - blood; Myocardial Ischemia - diagnosis; Myocardial Ischemia - etiology; Myocardial Ischemia - mortality; Orthopedic Procedures; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - mortality; Postoperative Period; Preoperative Period; Prospective Studies; Risk Factors; ROC Curve; Single-Blind Method; Troponin I - blood
• ISSN: 0304-4602; 0304-4602
• DOI: 10.47102/annals-acadmedsg.V42N1p24

The relationship between electrocardiograph (ECG) changes and troponin levels after the emergency orthopaedic surgery are not well characterised. The aim of this study was to determine the correlation between ECG changes (ischaemia or arrhythmia), troponin elevations perioperatively and cardiac complications. One hundred and eighty-seven orthopaedic patients over 60 years of age were prospectively tested for troponin I and ECGs were performed on the fi rst 3 postoperative mornings or until discharge. The incidences of pre- and postoperative troponin elevation were 15.5% and 37.4% respectively, the majority were asymptomatically detected. Most of the patients who sustained a troponin rise did not have any concomitant ECG changes (51/70 or 72.9%). Postoperative ECG changes were noted in 18.4% (34/185) and of those with ECG changes, slightly more than half (55.9%) had a troponin elevation. Most ECG changes occurred on postoperative day 1 and were non-ST elevation in type. ECG changes occurred more frequently with higher troponin levels. Postoperative troponin elevation (P = 0.018) and not preoperative troponin level (P = 0.060) was associated with ECG changes on univariate analysis. Two premorbid factors were predictors of postoperative ECG changes using multivariate logistical regression; age [odds ratio (OR), 1.05; 95% CI, 1.005 to 1.100, P = 0.029) and sex OR, 2.4; 95% CI, 1.069 to 5.446, P = 0.034). Twenty patients sustained postoperative cardiac complications; 9 (45%) were associated with ECG changes and 16 (80%) with postoperative troponin elevation. Pre- or postoperative troponin elevation better predicted cardiac complications compared with preoperative ECG changes. Electrocardiograph changes do not necessarily accompany troponin elevations after the emergency orthopaedic surgery but are more likely to have higher troponin levels. The best predictor of postoperative cardiac complications is troponin elevation.