Should pre-operative troponin be a standard requirement in patients undergoing major lower extremity amputation?

Objectives. The objective of this study was to ascertain the benefit of routine pre-operative cardiac troponin I (cTnl) measurement in patients undergoing major lower extremity amputation for critical limb ischaemia. Design. This was a prospective, blinded observational study. Methods. All patients scheduled for lower extremity amputation, without evidence of unstable coronary artery disease were recruited prospectively over a period of 1 year. In addition to routine pre-operative evaluation, a blood sample was taken for measurement of serum cTnl. Post-operative screening was conducted for cardiac events with patients followed up to 6 weeks. Results. Ten of the 44 patients included suffered a non-fatal myocardial infarction or died from a cardiac cause postoperatively. A rise in pre-operative cTnI was associated with a very poor outcome (two cardiac deaths and one post-operative myocardial infarction) and was the only significant predictor of post-operative cardiac events. Conclusion. Routine pre-operative cTnI measurement may be of use to identify patients at high risk of cardiac complication who would benefit from optimization of cardiac status or in whom surgery could be deferred.