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CLINICAL RESEARCH: POSTOPERATIVE MORTALITY AFTER NON-CARDIAC SURGERY

Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease

Miodrag Filipovic, MD^*,*, Raban Jeger, MD, Cecilia Probst, MD^*, Thierry Girard, MD^*, Matthias Pfisterer, MD, Lorenz Gürke, MD, Karl Skarvan, MD^* and Manfred D. Seeberger, MD^*

^* Department of Anesthesia, Basel, Switzerland
Department of Anesthesia Internal Medicine, Division of Cardiology, Basel, Switzerland
Department of Anesthesia Surgery, University of Basel/Kantonsspital, Basel, Switzerland

Manuscript received April 2, 2003; accepted May 7, 2003.

^* Reprint requests and correspondence: Dr. Miodrag Filipovic, Department of Anesthesia, University of Basel/Kantonsspital, CH-4031 Basel, Switzerland.
mfilipovic{at}uhbs.ch

OBJECTIVES: The aim of this study was to determine whether perioperative measurements of heart rate variability (HRV) and cardiac troponin I (cTnI) add additional prognostic information to established risk scores for first-year mortality in patients at risk of coronary artery disease (CAD) undergoing major noncardiac surgery.

BACKGROUND: In cardiac-risk patients undergoing major noncardiac surgery, the short- and long-term prognoses are mainly influenced by perioperative cardiac complications. Heart rate variability and cTnI are important prognostic markers in patients with congestive heart failure and myocardial infarction.

METHODS: In a prospective study, 173 patients with CAD or at high risk of CAD undergoing major noncardiac surgery were followed up for one year. The main outcome measure was all-cause mortality. In addition to clinical parameters and established risk scores, HRV and cTnI were assessed perioperatively.

RESULTS: Twenty-eight (16%) patients died within one year. Multivariate logistic regression analysis revealed three findings that were independently associated with death within the first year after surgery: the revised cardiac risk index (odds ratio 6.2 [95% confidence interval 1.6 to 25], depressed HRV before induction of anesthesia (16.2 [2.8 to 94]), and elevation of cTnI on postoperative day 1 or 2 (9.8 [3.0 to 32]).

CONCLUSION: Depressed HRV before induction of anesthesia and elevated cTnI postoperatively are independent and powerful predictors of one-year mortality for patients at risk of CAD undergoing major noncardiac surgery and add incremental prognostic information to established risk scores that only consider preoperative information.

Abbreviations and Acronyms   CAD = coronary artery disease   CI = confidence interval   cTnI = cardiac troponin I   ECG = electrocardiography   HF = high-frequency power   HRV = heart rate variability   LF = low-frequency power   OR = odds ratio   ROC = receiver operating characteristics   TP = total power

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