ACUTE MYOCARDIAL INJURY AFTER SURGICAL LUNG RESECTION: INCIDENCE, CLINICAL FEATURES, PREDICTORS

Highlights

Acute perioperative myocardial injury develops in 38.5% of patients with non – small cell lung cancer and is associated with the ThRCRI major cardiac events risk index, preoperative hemoglobin level and postoperative heart rate.

Aim. To determine the incidence and predictors of acute myocardial injury after surgical treatment of patients with non – small cell lung cancer (NSCLC).

Methods. The study included 104 men aged 63.0 [58–67] years who underwent lung resection for NSCLC. Blood levels of cardiac troponin I (cTnI) were determined before and 24 and 48 hours after surgery. Myocardial injury after noncardiac surgery (MINS) was diagnosed when postoperative cTnI increased > 99^th percentile of the upper reference limit. Two patients with elevated cTnI of non-ischemic origin were excluded from the analysis. In groups with and without MINS, clinical parameters were compared and their relationships with the MINS development were assessed using univariate regression. Multivariate logistic regression analysis was performed to identify independent MINS predictors. ROC curves were constructed and threshold values of quantitative variables associated with the study outcome were determined.

Results. MINS was diagnosed in 40 patients (38.5%). In 36 of them, the cTnI increase was asymptomatic. Among patients with MINS, in contrast to the group without MINS, the share of pneumonectomy, heart rate (HR) after surgery and the cardiac events risk index ThRCRI were higher, as well as hemoglobin level before surgery was lower. Using multiple logistic regression, a combination of factors that provides the greatest accuracy in predicting MINS was identified: ThRCRI index ≥ 1 (adjusted odds ratio (OR) 5.85, 95% confidence interval [1.41–24.28]), hemoglobin before surgery (OR 0.68 [0.5–0.91] for every 10 g/L), HR after surgery (OR 1.99 [1.26–3.13] for every 10 min^–1). Threshold levels were established for hemoglobin before surgery (135 g/L), below which the OR for MINS was 2.54 [1.12–5.75], and postoperative HR (88 min^–1), above which the OR for MINS was 2.64 [1.16–5.99].

Conclusion. The incidence of acute myocardial injury after NSCLC surgery is 38.5%. In 90% of cases the MINS was asymptomatic. A mathematical model was created and following independent predictors of MINS were established: ThRCRI index ≥ 1, hemoglobin level before and heart rate after the surgery. At a threshold hemoglobin value < 135 g/L and HR>88 min^–1, the risk of MINS increases significantly.

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