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. 2013 Aug;166(2):325-332.e1.
doi: 10.1016/j.ahj.2013.04.018. Epub 2013 Jun 24.

High-sensitivity cardiac troponin T in prediction and diagnosis of myocardial infarction and long-term mortality after noncardiac surgery

Peter Nagele  1 , Frank Brown, Brian F Gage, David W Gibson, J Philip Miller, Allan S Jaffe, Fred S Apple, Mitchell G Scott
Affiliations

High-sensitivity cardiac troponin T in prediction and diagnosis of myocardial infarction and long-term mortality after noncardiac surgery

Peter Nagele et al. Am Heart J. 2013 Aug.

Abstract

Background: Perioperative myocardial infarction (MI) is a serious complication after noncardiac surgery. We hypothesized that preoperative cardiac troponin T detected with a novel high-sensitivity (hs-cTnT) assay will identify patients at risk for acute MI and long-term mortality after major noncardiac surgery.

Methods: This was a prospective cohort study within the VINO trial (n = 608). Patients had been diagnosed with or had multiple risk factors for coronary artery disease and underwent major noncardiac surgery. Cardiac troponin I (contemporary assay) and troponin T (high-sensitivity assay) and 12-lead electrocardiograms were obtained before and immediately after surgery and on postoperative days 1, 2, and 3.

Results: At baseline before surgery, 599 patients (98.5%) had a detectable hs-cTnT concentration, and 247 (41%) were >14 ng/L (99th percentile). After surgery, 497 patients (82%) had a rise in hs-cTnT (median change in hs-cTnT +2.7 ng/L [interquartile range 0.7-6.8]). During the first 3 postoperative days, there were 9 patients (2.5%) with a preoperative hs-cTnT <14 ng/L with acute MI, compared with 21 patients (8.6%) with a preoperative hs-cTnT >14 ng/L (odds ratio 3.67, 95% CI 1.65-8.15). During long-term follow-up, 80 deaths occurred. The 3-year mortality rate was 11% in patients with a preoperative hs-cTnT concentration <14 ng/L compared with 25% in patients with a preoperative hs-cTnT >14 ng/L (adjusted hazard ratio 2.17, 95% CI 1.19-3.96).

Conclusions: In this cohort of high-risk patients, preoperative hs-cTnT concentrations were significantly associated with postoperative MI and long-term mortality after noncardiac surgery.

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Figures

Figure 1
Figure 1
Distribution of Preoperative High-Sensitivity Troponin T Concentrations.
Figure 2
Figure 2. Preoperative High-sensitivity Troponin T and Postoperative Troponin Elevation and Myocardial Infarction
Patients are grouped into two groups using the 99th percentile high-sensitivity troponin T (hs-cTnT) (14 ng/L) as a cutoff.
Figure 3
Figure 3. Kaplan-Meier Survival Curves for All-Cause-Mortality According to Preoperative High-Sensitivity Troponin T Concentration
Groups are indicated by color. Patients are grouped into two groups using the 99th percentile high-sensitivity troponin T (hs-cTnT) (14 ng/L) as a cutoff.
Figure 4
Figure 4. Kaplan-Meier Survival Curves for All-Cause-Mortality Using a Sex-Specific 99th Percentile for the Preoperative High-Sensitivity Troponin T Concentration
The upper figure shows the survival characteristics of women using 10 ng/L as 99th percentile cutoff. The lower figure shows the survival characteristics for men using 15 ng/L as 99th percentile.
Figure 4
Figure 4. Kaplan-Meier Survival Curves for All-Cause-Mortality Using a Sex-Specific 99th Percentile for the Preoperative High-Sensitivity Troponin T Concentration
The upper figure shows the survival characteristics of women using 10 ng/L as 99th percentile cutoff. The lower figure shows the survival characteristics for men using 15 ng/L as 99th percentile.
Figure 4
Figure 4. Kaplan-Meier Survival Curves for All-Cause-Mortality Using a Sex-Specific 99th Percentile for the Preoperative High-Sensitivity Troponin T Concentration
The upper figure shows the survival characteristics of women using 10 ng/L as 99th percentile cutoff. The lower figure shows the survival characteristics for men using 15 ng/L as 99th percentile.
See this image and copyright information in PMC

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