Long-term mortality predictors in pulmonary embolism

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute Pulmonary embolism(PE)is a common and potentially fatal medical condition.In contemporary adult population,PE is associated with increased long-term mortality. Purpose Identify predictors of long-term all-cause mortality in patients(pts)admitted due to pulmonary embolism. Methods Retrospective single-center study of hospitalized pts with acute PE between 2015 and 2018.We evaluated comorbidities, admission(AD)presentation such as vitals(with hypotension defined as systolic blood pressure(SBP)<90mmHg,and tachycardia as >100ppm),lab analyses during in-hospital period,imaging features. Mortality(long-term >3months)was also assessed using national registry of citizens.We performed uni and multivariate analysis to compare clinical characteristics of pts who died and who survived,using Cox regression and Kaplan-Meier methods.For the predictor age we assessed discrimination power and defined the best cut-off using area under the ROC curve(AUC)method. Results From 2015 to 2018,182 pts were admitted with diagnosis of pulmonary embolism,60% female with a mean age of 74 ± 13years old.Seventy-one(39%)pts died after a median follow-up of 26[10-41]months.Pts who died were older(80 ± 8 vs71 ± 14,p < 0.001).The best cut-off value of age to predict mortality with 70%sensitivity and 61%specificity was 77years old(AUC 0.703;CI95% 0.63-0.78).Pts who died had more frequently history of neoplasia (21%vs 9%,p = 0.009).The remaining comorbidities were similar in both groups.Pts who did not survive were more frequently hypotensive(28% vs 13%, p = 0.008),had higher creatinine(1.1[0.8-1.4] vs 1.0[0.8-1.2], p = 0.002), lactate(2.3[1.8-2.8]vs 1.8[1.5-2.0],p = 0.007)and NT-proBNP(4694[1498-12300]vs2070[492-6660], p < 0.001)at AD.Maximum troponin I (0.176[0.037-0.727]vs0.126[0.050-0.365]ng/mL,p = 0.012) was also higher than in pts who survived. After adjusting for history of neoplasia,ADcreatinine and maximum troponin I,we found that age (HR1.057;95%CI 1.01-1.11,p = 0.021),AD SBP < 90(HR 2.215;95%CI 1.03-4.76,p = 0.041),lactate(HR 1.17;95%CI 1.01-1.36,p = 0.035)and NT-proBNP(HR 1.510;95%CI 1.250-1.780,p < 0.001)were independent predictors of all-cause mortality. Conclusion In our cohort,the long-term all-cause mortality was 39%over a median follow-up of 26[10-41]months.In patients with pulmonary embolism,aside from already identified age(especially when ≥70 years old)and NT-proBNP,lactate should also be considered when evaluating long-term prognosis. Furthermore,hypotension at admission increases by 2fold long-term mortality in patients who suffered acute PE.

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Long-term mortality after massive, submassive, and low-risk pulmonary embolism

Vascular Medicine ◽

10.1177/1358863x19886374 ◽

2019 ◽

Vol 25 (2) ◽

pp. 141-149 ◽

Cited By ~ 5

Author(s):

Rajesh Gupta ◽

Zaid Ammari ◽

Osama Dasa ◽

Mohammed Ruzieh ◽

Jordan J Burlen ◽

...

Keyword(s):

Pulmonary Embolism ◽

Mortality Rate ◽

Tertiary Care ◽

Low Risk ◽

All Cause Mortality ◽

Acute Pe ◽

Long Term Mortality ◽

Overall Mortality

Guidelines for management of normotensive patients with acute pulmonary embolism (PE) emphasize further risk stratification on the basis of right ventricular (RV) size and biomarkers of RV injury or strain; however, the prognostic importance of these factors on long-term mortality is not known. We performed a retrospective cohort study of subjects diagnosed with acute PE from 2010 to 2015 at a tertiary care academic medical center. The severity of initial PE presentation was categorized into three groups: massive, submassive, and low-risk PE. The primary endpoint of all-cause mortality was ascertained using the Centers for Disease Control National Death Index (CDC NDI). A total of 183 subjects were studied and their median follow-up was 4.1 years. The median age was 65 years. The 30-day mortality rate was 7.7% and the overall mortality rate through the end of follow-up was 40.4%. The overall mortality rates for massive, submassive, and low-risk PE were 71.4%, 44.5%, and 28.1%, respectively ( p < 0.001). Landmark analysis using a 30-day cutpoint demonstrated that subjects presenting with submassive PE compared with low-risk PE had increased mortality during both the short- and the long-term periods. The most frequent causes of death were malignancy, cardiac disease, respiratory disease, and PE. Independent predictors of all-cause mortality were cancer at baseline, age, white blood cell count, diabetes mellitus, liver disease, female sex, and initial presentation with massive PE. In conclusion, the diagnosis of acute PE was associated with substantial long-term mortality. The severity of initial PE presentation was associated with both short- and long-term mortality.

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Catheter-Directed Therapies in Patients with Pulmonary Embolism: Predictive Factors of In-Hospital Mortality and Long-Term Follow-Up

Journal of Clinical Medicine ◽

10.3390/jcm10204716 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4716

Author(s):

Jesús Ribas ◽

Joana Valcárcel ◽

Esther Alba ◽

Yolanda Ruíz ◽

Daniel Cuartero ◽

...

Keyword(s):

Pulmonary Embolism ◽

Predictive Factors ◽

Mortality Rates ◽

Ivc Filter ◽

All Cause Mortality ◽

Filter Insertion ◽

Acute Pe ◽

Long Term Mortality

(1) Background: Catheter-directed therapies (CDT) may be considered for selected patients with pulmonary embolism (PE); (2) Methods: Retrospective observational study including all consecutive patients with acute PE undergoing CDT (mechanical or pharmacomechanical) from January 2010 through December 2020. The aim was to evaluate in-hospital and long-term mortality and its predictive factors; (3) Results: We included 63 patients, 43 (68.3%) with high-risk PE. All patients underwent mechanical CDT and, additionally, 27 (43%) underwent catheter-directed thrombolysis. Twelve (19%) patients received failed systemic thrombolysis (ST) prior to CDT, and an inferior vena cava (IVC) filter was inserted in 28 (44.5%) patients. In-hospital PE-related and all-cause mortality rates were 31.7%; 95% CI 20.6–44.7% and 42.9%; 95% CI 30.5–56%, respectively. In multivariate analysis, age > 70 years and previous ST were strongly associated with PE-related and all-cause mortality, while IVC filter insertion during the CDT was associated with lower mortality rates. After a median follow-up of 40 (12–60) months, 11 more patients died (mortality rate of 60.3%; 95% CI 47.2–72.4%). Long-term survival was significantly higher in patients who received an IVC filter; (4) Conclusions: Age > 70 years and failure of previous ST were associated with mortality in acute PE patients treated with CDT. In-hospital and long-term mortality were lower in patients who received IVC filter insertion.

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P1885Cha2ds-2vasc score lacks of ability to predict mortality in patients attending the emergency department with atrial fibrillation in the presence of troponin i

European Heart Journal ◽

10.1093/eurheartj/ehz748.0633 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M I Gonzalez Del Hoyo ◽

G Cediel ◽

A Carrasquer ◽

G Bonet ◽

K Vasquez-Nunez ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Emergency Department ◽

Regression Analysis ◽

Troponin I ◽

Cox Regression ◽

Cox Regression Analysis ◽

All Cause Mortality

Abstract Background CHA2DS2-VASc score has been used as a surrogate marker for predicting outcomes beyond thromboembolic risk in patients with atrial fibrillation (AF). Likewise, cardiac troponin I (cTnI) is a predictor of mortality in AF. Purpose This study aimed to investigate the association of cTnI and CHA2DS2-VASc score with long-term prognosis in patients admitted to the emergency department with AF. Methods A retrospective cohort study conducted between January 2012 and December 2013, enrolling patients admitted to the emergency department with AF and having documented cTnI measurements. CHA2DS2-VASc score was estimated. Primary endpoint was 5-year all-cause mortality, readmission for heart failure (HF), readmission for myocardial infarction (MI) and the composite end point of major adverse cardiac events defined as death, readmission for HF or readmission for MI (MACE). Results A total of 578 patients with AF were studied, of whom 252 patients had elevated levels of cTnI (43.6%) and 334 patients had CHA2DS2-VASc score >3 (57.8%). Patients with elevated cTnI tended to be oldercompared with those who did not have cTnI elevation and were more frequently comorbid and of higher ischemic risk, including hypertension, prior MI, prior HF, chronic renal failure and peripheral artery disease. The overall median CHA2DS2-VASc score was higher in those with cTnI elevation compared to those patients elevated cTnI levels (4.2 vs 3.3 points, p<0.001). Main diagnoses at hospital discharge were tachyarrhythmia 30.3%, followed by heart failure 17.7%, respiratory infections 9.5% and acute coronary syndrome 7.3%. At 5-year follow-up, all-cause death was significantly higher for patients with cTnI elevation compared with those who did not have cTnI elevation (56.4% vs. 27%; logrank test p<0.001). Specifically, for readmissions for HF and readmissions for MI there were no differences in between patients with or without cTnI elevation. In addition, MACE was reached in 165 patients (65.5%) with cTnI elevation, compare to 126 patients (38.7%) without cTnI elevation (p<0.001). On multivariable Cox regression analysis, cTnI elevation was an independent predictor of all-cause death (hazard ratio, 1.67, 95% confidence interval [CI]: 1.24–2.26, p=0.001) and of MACE (hazard ratio 1.47, 95% confidence interval 1.15–1.88; P=0.002), but it did not reach statistical significance for readmissions for MI and readmissions for HF. CHA2DS2-VASc score was a predictor on univariate Cox regression analysis for each endpoint, but it did not reach significance on multivariable Cox regression analysis for any endpoint. Conclusions cTnI is independently associated with long-term all-cause mortality in patients attending the emergency department with AF. cTnI compared to CHA2DS2-VASc score is thus a biomarker with predictive capacity for mortality in late follow-up, conferring utility in the risk stratification of patients with atrial fibrillation.

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Joint analysis of D-dimer, N-terminal pro b-type natriuretic peptide, and cardiac troponin I on predicting acute pulmonary embolism relapse and mortality

Scientific Reports ◽

10.1038/s41598-021-94346-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaoyu Liu ◽

Liying Zheng ◽

Jing Han ◽

Lu Song ◽

Hemei Geng ◽

...

Keyword(s):

Pulmonary Embolism ◽

Survival Rate ◽

Adverse Events ◽

Acute Pulmonary Embolism ◽

Troponin I ◽

All Cause Mortality ◽

Long Term Prognosis ◽

D Dimer

AbstractPrevious studies on the adverse events of acute pulmonary embolism (APE) were mostly limited to single marker, and short follow-up duration, from hospitalization to up to 30 days. We aimed to predict the long-term prognosis of patients with APE by joint assessment of D-dimer, N-Terminal Pro-Brain Natriuretic Peptide (NT-ProBNP), and troponin I (cTnI). Newly diagnosed patients of APE from January 2011 to December 2015 were recruited from three hospitals. Medical information of the patients was collected retrospectively by reviewing medical records. Adverse events (APE recurrence and all-cause mortality) of all enrolled patients were followed up via telephone. D-dimer > 0.50 mg/L, NT-ProBNP > 500 pg/mL, and cTnI > 0.40 ng/mL were defined as the abnormal. Kaplan–Meier curve was used to compare the cumulative survival rate between patients with different numbers of abnormal markers. Cox proportional hazard regression model was used to further test the association between numbers of abnormal markers and long-term prognosis of patients with APE after adjusting for potential confounding. During follow-up, APE recurrence and all-cause mortality happened in 78 (30.1%) patients. The proportion of APE recurrence and death in one abnormal marker, two abnormal markers, and three abnormal markers groups were 7.69%, 28.21%, and 64.10% respectively. Patients with three abnormal markers had the lowest survival rate than those with one or two abnormal markers (Log-rank test, P < 0.001). After adjustment, patients with two or three abnormal markers had a significantly higher risk of the total adverse event compared to those with one abnormal marker. The hazard ratios (95% confidence interval) were 6.27 (3.24, 12.12) and 10.7 (4.1, 28.0), respectively. Separate analyses for APE recurrence and all-cause death found similar results. A joint test of abnormal D-dimer, NT-ProBNP, and cTnI in APE patients could better predict the long-term risk of APE recurrence and all-cause mortality.

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Utility of plasma galectin-3 in predicting long-term mortality in patients with acute heart failure

Biomedical Research and Therapy ◽

10.15419/bmrat.v8i4.669 ◽

2021 ◽

Vol 8 (4) ◽

pp. 4306-4314

Author(s):

Hoang Van Sy ◽

Dang Quang Toan ◽

Ta Thi-Thanh Huong ◽

Chau Ngoc Hoa ◽

Tran Kim Trang

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Troponin I ◽

All Cause Mortality ◽

Galectin 3 ◽

One Year ◽

Time Of Admission ◽

Long Term Mortality

Background: Several studies have investigated Galectin-3 as a promising biomarker for predicting the short-term and long-term mortality of patients with acute heart failure. This study aimed to examine the usefulness of plasma galectin-3 at the time of admission in predicting long-term mortality in Vietnamese patients with acute heart failure (AHF). Methods: We carried out a cohort study including 117 patients consecutively diagnosed with acute heart failure in a single cardiology department. Plasma galectin-3 and other biomarkers were measured at the time of admission. The patient’s clinical and analytical characteristics were recorded. The main endpoint was one-year all-cause mortality. Results: There were six patients (5%) lost to follow-up and 59 patients (53.2%) reaching primary outcome within one year after ‎hospital admission.‎ The median plasma galectin-3 level (ng/mL) in patients with acute heart failure was 34.6 (26.7 – 44.1). Plasma galectin-3 in the alive group was significantly higher than that in the deceased group at one-year follow-up. In predicting one-year all-cause mortality, galectin-3 had an area under the curve (AUC) of 0.71 (95% confidence interval (CI), 0.62 – 0.81) representing a good prognostic factor while brain natriuretic peptide (BNP) and troponin I were inferior to galectin-3 with an AUC of 0.69 (95% CI, 0.59 – 0.79) and 0.63 (95% CI, 0.53 – 0.74), respectively. The optimal cut-off value for galectin-3 was 40.75 ng/mL with a sensitivity of 50.1% and a specificity of 88.5%. In a multivariate model, patients with galectin-3 levels > 40.75 ng/mL had a hazard ratio (HR) of 2.8 (95% CI, 1.5 – 5; p = 0.001). The best prediction model was the combined model of galectin-3 and BNP, yielding an AUC of 0.78 (95% CI, 0.70 – 0.86; p < 0.001). Conclusions: Our study suggested that galectin-3 levels could predict long-term all-cause mortality in patients with acute heart failure with a good prognostic capacity. Combining galectin-3 and BNP could bring up a better risk-stratification.

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Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

Medical Principles and Practice ◽

10.1159/000497436 ◽

2019 ◽

Vol 28 (3) ◽

pp. 264-272 ◽

Cited By ~ 2

Author(s):

Valdis Ģībietis ◽

Dana Kigitoviča ◽

Barbara Vītola ◽

Sintija Strautmane ◽

Andris Skride

Keyword(s):

Pulmonary Embolism ◽

Glomerular Filtration Rate ◽

Filtration Rate ◽

Acute Pulmonary Embolism ◽

All Cause Mortality ◽

Acute Pe ◽

D Dimer ◽

Active Cancer ◽

Long Term Mortality

Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919–0.979; 1-year: HR 0.967, 95% CI 0.943–0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915–0.983; 1-year: HR 0.971, 95% CI 0.945–0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.

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Can Inr on Admission Be a New Prognostic Parameter in Patients with Acute Pulmonary Embolism?

10.20944/preprints202107.0109.v1 ◽

2021 ◽

Author(s):

Katarzyna Ptaszyńska-Kopczyńska ◽

Emilia Sawicka ◽

Michał Ciurzyński ◽

Robert Milewski ◽

Izabela Kiluk ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Cox Regression ◽

Systolic Pulmonary Artery Pressure ◽

Lower Systolic Blood Pressure ◽

Risk Of Death ◽

Acute Pe ◽

D Dimer ◽

Long Term Mortality

Pulmonary embolism (PE) is one of the leading causes of cardiovascular mortality, therefore new parameters regarding risk stratification are sought after. In patients admitted for acute PE we investigated associations between the initial coagulation impairment, expressed by prothrombin time international normalised ratio (INR), and parameters reflecting PE severity. Furthermore, in-hospital, 30-day and long-term mortality were also evaluated. The analysis included 848 patients who were divided into two groups: with normal INR≤1.2, and elevated INR>1.2 (252 patients, 29.7%). The group with elevated INR presented higher incidence of tachycardia and lower systolic blood pressure, higher CRP, d-dimer, and NT-proBNP. This group presented higher estimated systolic pulmonary artery pressure (49 IQR39-62mmHg vs 43 IQR32-53mmHg, p<0.001) and shorter pulmonary artery acceleration time (65 IQR55-85ms vs 81 IQR63-102ms; p<0.001). Patients with elevated INR had more often a sPESI of 1 or higher (78%vs60%, p=0.003). Cox regression model revealed that age, leukocyte level, SBP, neoplasm, and INR are associated with higher risk of death (p<0.001). Finally, elevated INR was associated with higher in-hospital (13%vs3%; p<0.001), 30-day (19%vs6%; p<0.001), and long-term mortality (p<0.001). Summing up, elevated INR on admission is frequent in patients with PE, reflects worse clinical condition and is related to PE severity and prognosis.

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764 Elevated cardiac troponin I levels in acute pulmonary embolism predict increased long-term mortality

European Heart Journal ◽

10.1016/s0195-668x(03)94166-2 ◽

2003 ◽

Vol 24 (5) ◽

pp. 138 ◽

Cited By ~ 1

Author(s):

J SALLACH

Keyword(s):

Pulmonary Embolism ◽

Cardiac Troponin ◽

Acute Pulmonary Embolism ◽

Troponin I ◽

Cardiac Troponin I ◽

Long Term Mortality

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Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.0983 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Huang ◽

C Liu

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ejection Fraction ◽

Funding Source ◽

Preserved Ejection Fraction ◽

Risk Of Mortality ◽

All Cause Mortality ◽

History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: <120mmHg, ≥120mmHg and <130mmHg, ≥130mmHg and <140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of <120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of <120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

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Characteristics and long-term mortality of patients with ST-elevation or non-ST-elevation myocardial infarction after orthopaedic surgery

Journal of International Medical Research ◽

10.1177/0300060521992995 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199299

Author(s):

Wenlan Hu ◽

Kaiping Zhao ◽

Youzhou Chen ◽

Jihong Wang ◽

Mei Zheng ◽

...

Keyword(s):

Myocardial Infarction ◽

Orthopaedic Surgery ◽

Troponin I ◽

Cox Regression ◽

St Elevation Myocardial Infarction ◽

Entire Cohort ◽

St Elevation ◽

Universal Definition ◽

Long Term Mortality

Objective To investigate the clinical characteristics and long-term mortality of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) after orthopaedic surgery. Methods This retrospective, single-centre study enrolled patients that underwent inpatient orthopaedic surgery from 2009 to 2017 in Beijing Jishuitan Hospital. The patients were screened for a cardiac troponin I elevation and fulfilled the Fourth Universal Definition of Myocardial Infarction within 30 days of surgery. Results A total of 180 patients that developed perioperative myocardial infarction (MI) were included in the study. Among them, 14 patients (7.8%) were classified as STEMI, and 166 (92.2%) had NSTEMI. Compared with those with NSTEMI, STEMI patients had significantly higher 30-day and long-term mortality rates (50.0% versus 5.4%; 71.4% versus 22.3%; respectively). Multivariate Cox regression model analysis among the entire cohort demonstrated that STEMI (hazard ratio [HR] 5.78, 95% confidence interval [CI] 2.50, 13.38) and prior MI (HR 2.35, 95% CI 1.02, 5.38) were the most significant independent predictors of long-term mortality. Conclusion Perioperative MI after orthopaedic surgery was associated with a high mortality rate. STEMI was independently associated with a significant increase in short- and long-term mortality.

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