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Myocardial ischaemia after hip and knee arthroplasty: incidence and risk factors

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Abstract

Purpose

Because the occurrence of postoperative myocardial ischaemia (MI) predicts subsequent cardiac morbidity and mortality, we determined the prevalence of and risk factors for MI in hip and knee arthroplasty patients.

Methods

High-sensitivity cardiac troponin T (hs-cTnT) was measured on stored samples from postoperative day two in 394 hip and knee arthroplasty patients ≥ 65 years of age enrolled in the Genetics-InFormatics Trial (GIFT).

Results

Fifty-three (13.5 %) participants had MI, of whom only three were diagnosed clinically during their hospitalisation. The risk of MI increased with age [odds ratio (OR) 3.52 per decade, 95 % confidence interval (CI) 2.00–6.19] and diabetes (OR 2.23, 95 % CI 1.04–4.77). MI was rarer with statins (OR 0.74, 95 % CI 0.40–1.35) and more common with hypertension, coronary artery disease and tobacco use, although these were not statistically significant.

Conclusions

Subclinical MI occurs frequently after arthroplasty. Diabetic and elderly patients are at highest risk.

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References

  1. CDC (2013) FastStats: inpatient surgery

  2. Memtsoudis SG, Gonzalez Della Valle A, Besculides MC, Gaber L, Sculco TP (2008) In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges. Clin Orthop Relat Res 466:2617–2627. doi:10.1007/s11999-008-0402-5

    Article  PubMed Central  PubMed  Google Scholar 

  3. Hietala P, Strandberg M, Strandberg N, Gullichsen E, Airaksinen KE (2013) Perioperative myocardial infarctions are common and often unrecognized in patients undergoing hip fracture surgery. J Trauma Acute Care Surg 74:1087–1091. doi:10.1097/TA.0b013e3182827322

    Article  PubMed  Google Scholar 

  4. Chong CP, van Gaal WJ, Savige J, Lim WK (2011) Cardiac injury and troponin testing after orthopaedic surgery. Injury 42:855–863

    Article  PubMed  Google Scholar 

  5. Dawson-Bowling S, Chettiar K, Cottam H, Worth R, Forder J, Fitzgerald-O’Connor I, Walker D, Apthorp H (2008) Troponin T as a predictive marker of morbidity in patients with fractured neck of femur. Injury 39:775–780. doi:10.1016/j. injury .2008.01.025

    Article  PubMed  Google Scholar 

  6. Sandhu A, Sanders S, Geraci SA (2013) Prognostic value of cardiac troponins in elderly patients with hip fracture--a systematic review. Osteoporos Int 24:1145–1149. doi:10.1007/s00198-012-2116-5

    Article  CAS  PubMed  Google Scholar 

  7. Talsnes O, Hjelmstedt F, Dahl OE, Pripp AH, Reikeras O (2011) Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly. Int Orthop 35:903–907. doi:10.1007/s00264-010-1149-7

    Article  PubMed Central  PubMed  Google Scholar 

  8. Mangano DT, Browner WS, Hollenberg M, Li J, Tateo IM (1992) Long-term cardiac prognosis following noncardiac surgery. the study of perioperative ischemia research group. JAMA 268:233–239

    Article  CAS  PubMed  Google Scholar 

  9. Nagele P, Brown F, Gage BF, Gibson DW, Miller JP, Jaffe AS, Apple FS, Scott MG (2013) High-sensitivity cardiac troponin T in prediction and diagnosis of myocardial infarction and long-term mortality after noncardiac surgery. Am Heart J 166:325–332.e1. doi:10.1016/j.ahj.2013.04.018

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators, Devereaux PJ, Chan MT, Alonso-Coello P, Walsh M et al (2012) Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA 307:2295–2304. doi:10.1001/jama.2012.5502

    Article  Google Scholar 

  11. POISE Study Group, Devereaux PJ, Yang H, Yusuf S, Guyatt G et al (2008) Effects of extended-release metoprolol succinate in patients undergoing noncardiac surgery (POISE trial): a randomised controlled trial. Lancet 371:1839–1847. doi:10.1016/S0140-6736(08)60601-7

    Article  Google Scholar 

  12. PEP (2000) Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary embolism prevention (PEP) trial. Lancet 355:1295–1302

    Article  Google Scholar 

  13. Oscarsson A, Gupta A, Fredrikson M, Jarhult J, Nystrom M, Pettersson E, Darvish B, Krook H, Swahn E, Eintrei C (2010) To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth 104:305–312. doi:10.1093/bja/aeq003

    Article  CAS  PubMed  Google Scholar 

  14. Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P et al (2014) Aspirin in patients undergoing noncardiac surgery. N Engl J Med 370:1494–1503. doi:10.1056/NEJMoa1401105

    Article  CAS  PubMed  Google Scholar 

  15. Durazzo AE, Machado FS, Ikeoka DT, De Bernoche C, Monachini MC, Puech-Leao P, Caramelli B (2004) Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 39:967–975; discussion 975–6. doi:10.1016/j.jvs.2004.01.004

  16. Schouten O, Boersma E, Hoeks SE, Benner R, van Urk H et al (2009) Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med 361:980–989. doi:10.1056/NEJMoa0808207

    Article  CAS  PubMed  Google Scholar 

  17. Winchester DE, Wen X, Xie L, Bavry AA (2010) Evidence of preprocedural statin therapy a meta-analysis of randomized trials. J Am Coll Cardiol 56:1099–1109. doi:10.1016/j.jacc.2010.04.023

    Article  PubMed  Google Scholar 

  18. Do EJ, Lenzini P, Eby CS, Bass AR, McMillin GA et al (2011) Genetics informatics trial (GIFT) of warfarin to prevent deep vein thrombosis (DVT): rationale and study design. Pharmacogenomics J. doi:10.1038/tpj.2011.18

    PubMed Central  PubMed  Google Scholar 

  19. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424. doi:10.1080/00273171.2011.568786

    Article  Google Scholar 

  20. McMillin GA, Melis R, Wilson A, Strong MB, Wanner NA, Vinik RG, Peters CL, Pendleton RC (2010) Gene-based warfarin dosing compared with standard of care practices in an orthopedic surgery population: a prospective, parallel cohort study. Ther Drug Monit 32:338–345. doi:10.1097/FTD.0b013e3181d925bb

    Article  CAS  PubMed  Google Scholar 

  21. Singh JA, Jensen MR, Harmsen WS, Gabriel SE, Lewallen DG (2011) Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty. Ann Rheum Dis 70:2082–2088. doi:10.1136/ard.2010.148726

    Article  PubMed Central  PubMed  Google Scholar 

  22. Pedersen AB, Mehnert F, Sorensen HT, Emmeluth C, Overgaard S, Johnsen SP (2014) The risk of venous thromboembolism, myocardial infarction, stroke, major bleeding and death in patients undergoing total hip and knee replacement: a 15-year retrospective cohort study of routine clinical practice. Bone Joint J 96:479–485. doi:10.1302/0301-620X.96B4.33209

    Article  PubMed  Google Scholar 

  23. Hagen TP, Vaughan-Sarrazin MS, Cram P (2010) Relation between hospital orthopaedic specialisation and outcomes in patients aged 65 and older: retrospective analysis of US medicare data. BMJ 340:c165. doi:10.1136/bmj.c165

    Article  PubMed Central  PubMed  Google Scholar 

  24. Menendez ME, Memtsoudis SG, Opperer M, Boettner F, Gonzalez Della Valle A (2014) A nationwide analysis of risk factors for in-hospital myocardial infarction after total joint arthroplasty. Int Orthop. doi:10.1007/s00264-014-2502-z

    PubMed  Google Scholar 

  25. Thornqvist C, Gislason GH, Kober L, Jensen PF, Torp Pedersen C, Andersson C (2014) Body mass index and risk of perioperative cardiovascular adverse events and mortality in 34,744 danish patients undergoing hip or knee replacement. Acta Orthop 85:456–462. doi:10.3109/17453674.2014.934184

    Article  PubMed Central  PubMed  Google Scholar 

  26. Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C et al (2009) Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 361:858–867. doi:10.1056/NEJMoa0900428

    Article  CAS  PubMed  Google Scholar 

  27. Kawahara C, Tsutamoto T, Nishiyama K, Yamaji M, Sakai H, Fujii M, Yamamoto T, Horie M (2011) Prognostic role of high-sensitivity cardiac troponin T in patients with nonischemic dilated cardiomyopathy. Circ J 75:656–661

    Article  PubMed  Google Scholar 

  28. Lindahl B, Venge P, James S (2010) The new high-sensitivity cardiac troponin T assay improves risk assessment in acute coronary syndromes. Am Heart J 160:224–229. doi:10.1016/j.ahj.2010.05.023

    Article  CAS  PubMed  Google Scholar 

  29. Urban MK, Jules-Elysee K, Loughlin C, Kelsey W, Flynn E (2008) The one year incidence of postoperative myocardial infarction in an orthopedic population. HSS J 4:76–80. doi:10.1007/s11420-007-9070-3

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Hietala P, Strandberg M, Kiviniemi T, Strandberg N, Airaksinen KE (2014) Usefulness of troponin T to predict short-term and long-term mortality in patients after hip fracture. Am J Cardiol 114:193–197. doi:10.1016/j.amjcard.2014.04.026

    Article  CAS  PubMed  Google Scholar 

  31. DeLuca AJ, Kaplan S, Aronow WS, Sandhu R, Butt A, Akoybyan A, Weiss MB (2006) Comparison of prevalence of unrecognized myocardial infarction and of silent myocardial ischemia detected by a treadmill exercise sestamibi stress test in patients with versus without diabetes mellitus. Am J Cardiol 98:1045–1046. doi:10.1016/j.amjcard.2006.05.026

    Article  PubMed  Google Scholar 

  32. Arenja N, Mueller C, Ehl NF, Brinkert M, Roost K, Reichlin T, Sou SM, Hochgruber T, Osswald S, Zellweger MJ (2013) Prevalence, extent, and independent predictors of silent myocardial infarction. Am J Med 126:515–522. doi:10.1016/j.amjmed.2012.11.028

    Article  PubMed  Google Scholar 

  33. Sheifer SE, Gersh BJ, Yanez ND 3rd, Ades PA, Burke GL, Manolio TA (2000) Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly. J Am Coll Cardiol 35:119–126

    Article  CAS  PubMed  Google Scholar 

  34. Bozic KJ, Bashyal RK, Anthony SG, Chiu V, Shulman B, Rubash HE (2013) Is administratively coded comorbidity and complication dat a in total joint arthroplasty valid? Clin Orthop Relat Res 471:201–205. doi:10.1007/s11999-012-2352-1

    Article  PubMed Central  PubMed  Google Scholar 

  35. Wolf BR, Lu X, Li Y, Callaghan JJ, Cram P (2012) Adverse outcomes in hip arthroplasty: long-term trends. J Bone Joint Surg Am 94:e103. doi:10.2106/JBJS.K.00011

    Article  PubMed Central  PubMed  Google Scholar 

  36. Criner KT, Trionfo A (2014) Impact of statins on postoperative venous thromboembolic events following total knee and hip replacements. AAOS Scientific Meeting Poster: Poster 204

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Acknowledgments

Funding for high-sensitivity troponin T testing was provided by the Weill Cornell Clinical & Translational Science Center (UL1 TR000457-06). The Genetics InFormatics Trial (GIFT) of Warfarin Therapy to Prevent DVT is funded by the National Heart Lung Blood Institute (R01 HL097036).

Conflict of interest

The authors have no conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, 535 E 70th Street, New York, NY, 10021, USA

    Anne Ruth Bass

  2. Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA

    Tomás Rodriguez, Gina Hyun & Brian Foster Gage

  3. Clinical and Translational Science Center, Weill Cornell Medical College, 525 East 68th Street, Room A-150, New York, NY, 10065, USA

    Francisco Gerardo Santiago

  4. New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA

    Jacqueline Ilji Kim

  5. Intermountain Medical Center, University of Utah School of Medicine, PO Box 57700, Murray, UT, 84157-7000, USA

    Scott Christopher Woller

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  1. Anne Ruth Bass
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Corresponding author

Correspondence to Anne Ruth Bass.

Appendix

Appendix

Table 3 Patient characteristics before and after applying inverse probability treatment of weighting propensity score (IPTW) propensity score
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Bass, A.R., Rodriguez, T., Hyun, G. et al. Myocardial ischaemia after hip and knee arthroplasty: incidence and risk factors. International Orthopaedics (SICOT) 39, 2011–2016 (2015). https://doi.org/10.1007/s00264-015-2853-0

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  • DOI: https://doi.org/10.1007/s00264-015-2853-0

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