Immediate postoperative high-sensitivity troponin T concentrations and long-term patient-reported health-related quality of life A prospective cohort study

BACKGROUND Myocardial injury after noncardiac surgery is associated with mortality and major adverse postoperative cardiovascular events. The effect of postoperative troponin concentrations on patient-reported health-related quality of life (HRQoL) is unknown. OBJECTIVE The study examined the association between immediate postoperative troponin concentrations and selfreported HRQoL 1 year after surgery. DESIGN Prospective cohort study. SETTING Single-centre tertiary care hospital in the Netherlands between July 2012 and 2015. PATIENTS Patients aged at least 60 years undergoing moderate and major noncardiac surgery. INTERVENTION None. MAIN OUTCOME MEASURES HRQoL total score was assessed with the EuroQol five-dimensional questionnaire. Tobit regression analysis was used to determine the association between postoperative troponin concentrations and 1-year HRQoL. Peak high-sensitivity troponin T values were divided into four categories: less than 14, 14 to 49, 50 to 149 and at least 150 ng l1 . RESULTS A total of 3085 patients with troponin measurements were included. 2634 (85.4%) patients were alive at 1- year follow-up of whom 1297 (49.2%) returned a completed questionnaire. The median score for HRQoL was 0.82 (0.85, 0.81, 0.77 and 0.71 per increasing troponin category). Multivariable analysis revealed betas of 0.06 [95% confidence interval (CI) 0.09 to 0.02], 0.11 (95% CI 0.18 to 0.04) and 0.18 (95% CI 0.29 to 0.07) for troponin levels of 14 to 49, 50 to 149 and at least 150 ng l1 when compared with values less than 14 ng l1 . Other independent predictors for lower HRQoL were chronic obstructive pulmonary disease, female sex, peripheral arterial disease and increasing age. CONCLUSION Higher levels of postoperative troponin measured immediately after surgery were independently associated with lower self-reported HRQoL total score at 1-year follow-up.

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