Myocardial Injury After Orthopedic Surgery Surprisingly Common

While myocardial injury is common after noncardiac surgery, not much is known about their risk in orthopedic procedures.

In “Association Between Myocardial Injury and Cardiovascular Outcomes of Orthopaedic Surgery,” published online on March 2, 2020 in the Journal of Bone & Joint Surgery, researchers analyzed data from 15,103 patients 45 years of age or older who had undergone inpatient noncardiac surgery, 3,092 of which had an orthopedic procedure. ()

The research team performed non-high-sensitivity troponin T (TnT) assays on patients at days 0,1,2 and 3 post operatively. The researchers also calculated 30-day mortality rates for those with and without myocardial injury.

Of the 3,092 orthopedic patients for whom data was collected, 367 had myocardial injury. Orthopedic patients without myocardial injury had a 30-day mortality rate of 1.0% while those with myocardial injury had a 30-day mortality rate of 9.8% (OR, 11.28; 95% CI, 6.72 to 18.92). Myocardial injury was associated with 30-day mortality for all surgical patients.

Those patients with myocardial injury who had an ischemic feature, meaning symptoms or evidence of ischemia on electrocardiography or imaging, had a higher 30-day mortality rate. But so did those patients with myocardial injury who did not have an ischemic feature. About 81.3% of orthopedic patients with myocardial injury were asymptomatic and therefore their myocardial injury would have probably gone undetected without TnT monitoring.

The researchers wrote, “One in 8 orthopaedic patients in our study had myocardial injury, and myocardial injury was associated with a higher mortality rate regardless of symptoms. Troponin levels should be measured after surgery in at-risk patients because most myocardial injury cases (>80%) are asymptomatic and would go undetected without routine measurements.”