Features  |   May 2017
The Higher the Peak Troponin, the Quicker the March Toward Death: Could This Be True?
Author Affiliations
  • Kenneth Y. Pauker, M.D.
    Committee on Patient Safety and Education
  • Melissa Kreso, M.D.
    Committee on Patient Safety and Education
  • Nikhil Thakkar, M.D.
    Committee on Patient Safety and Education
  • Brett L. Arron, M.D.
    Committee on Patient Safety and Education
Article Information
Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Trauma / Burn Care / Quality Improvement / Features
Features   |   May 2017
The Higher the Peak Troponin, the Quicker the March Toward Death: Could This Be True?
ASA Monitor 05 2017, Vol.81, 22-25.
ASA Monitor 05 2017, Vol.81, 22-25.
Perioperative mortality from all causes with 48 hours of anesthetic care in the United States is approximately 1/500 (0.2 percent).1  If one extends the perioperative period out to 30 days after anesthetic care, that number increases 10-fold to roughly 2 percent.2,3 If the 30-day interval after surgery were considered a disease, it would be the third-leading cause of death in the U.S.4 
In a large international study, 8 percent of patients >age 45sustain a post-operative myocardial injury, as defined by a troponin elevation that appears to be of ischemic origin, but only 42 percent meet criteria to be called a myocardial infarction (MI).3 -5 Sixty-five percent are clinically silent, undetectable without biomarker testing.6  Nonetheless – silent or notmortality is nearly identical. These are the same patients we have always anesthetized – and felt to have done so successfully – but now, with biomarker assays of increased sensitivity, we should re-examine them with fresh eyes.
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