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Myocardial injury in elderly patients after abdominal surgery

  • Shun Huang
  • WenPing Peng
  • Ning Yang
  • Tao Yu
  • Hong Yuan Cui
  • Jing Yong Xu
  • Qi An
  • Hua Yang
  • Yan Nan Liu
  • Zhe Li
  • Ming Zhang Zuo
Original Article

Abstract

Background

The development of sensitive myocardial-specific cardiac biomarkers allows for detection of very small amounts of myocardial injury or necrosis. Myocardial injury (MI) as a prelude of the serious perioperative complication myocardial infarction, should be paid more attention, especially in elderly susceptible patients. Myocardial injury after abdominal surgery in elderly patients has not been described yet. The objectives of this study were to identify the incidence, predictors, characteristics and the impact of MI on outcome in elderly patients underwent abdominal surgery.

Methods

Patients aged  ≥ 65 who underwent abdominal surgery longer than 2 h between January 2016 and March 2017 were reviewed. Patients with peak troponin I level of 0.04 ng/ml or greater (abnormal laboratory threshold) within once-administration-period and without non-ischemia troponin elevation proof (e.g., sepsis) were assessed for characteristics and prognosis. Risk factors of MI were determined by multivariable regression.

Results

Among 285 patients with whole information, 36 patients (12.6%) suffered MI, only 2 patients (0.7%) fulfilled definition of myocardial infarction. With most of them occurred within first 7 days after surgery. Multivariable analysis showed that coronary artery disease (CAD) history [odds ratio (OR) 2.817, P = 0.015], non-laparoscopic surgery (OR 5.181, P = 0.030), blood loss ≥ 800 ml (OR 3.430, P = 0.008), non-venous maintain (OR 2.105, P = 0.047), and infection (OR 4.887, P = 0.008) as risk factors for MI. MI was associated with longer hospital stay (P = 0.006), more cardiac consultation (P = 0.011), higher infection(P = 0.016) and reoperation(P = 0.026) rate.

Conclusion

MI is common in elderly patients who underwent abdominal surgery, while myocardial infarction is infrequent. They are both associated with risk factors and worse prognosis. MI deserves more attention especially in elderly patients. Troponin I measurement is a useful test after massive surgery, which can help risk-stratifying patients, effective preventing, prompt managing and predicting outcomes. Routine monitoring of cardiac biomarkers especially within 7 days after abdominal surgery in elderly patients is recommended.

Keywords

Myocardial injury Myocardial infarction Troponin I Abdominal surgery Retrospective study Risk factors 

Notes

Acknowledgements

Support was provided solely from Beijing Hospital, National Center of Gerontology sources. Doctor Research Project. BJ-2015-102. This study was conducted at Beijing Hospital, National Center of Gerontology.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest to disclose.

Ethical approval

This retrospective study had been approved by the Beijing Hospital Institutional Review Board (2016BJYYEC-030-01).

Informed consent

For this kind of study formal consent is not required.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Shun Huang
    • 1
  • WenPing Peng
    • 1
  • Ning Yang
    • 1
  • Tao Yu
    • 2
  • Hong Yuan Cui
    • 2
  • Jing Yong Xu
    • 2
  • Qi An
    • 2
  • Hua Yang
    • 2
  • Yan Nan Liu
    • 2
  • Zhe Li
    • 2
  • Ming Zhang Zuo
    • 1
  1. 1.Department of AnesthesiologyBeijing Hospital, National Center of Gerontology, ChinaBeijingPeople’s Republic of China
  2. 2.Department of SurgeryBeijing Hospital, National Center of GerontologyBeijingChina

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