. 2018 Jun;61(3):185-194.

doi: 10.1503/cjs.010217.

Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost-consequence analysis

Giovanna Lurati Buse¹, Braden Manns¹, Andre Lamy¹, Gordon Guyatt¹, Carisi A Polanczyk¹, Matthew T V Chan¹, Chew Yin Wang¹, Juan Carlos Villar¹, Alben Sigamani¹, Daniel I Sessler¹, Otavio Berwanger¹, Bruce M Biccard¹, Rupert Pearse¹, Gerard Urrútia¹, Wojciech Szczeklik¹, Ignacio Garutti¹, Sadeesh Srinathan¹, German Malaga¹, Valsa Abraham¹, Clara K Chow¹, Michael J Jacka¹, Maria Tiboni¹, Gareth Ackland¹, Danielle Macneil¹, Robert Sapsford¹, Martin Leuwer¹, Yannick Le Manach¹, Philip J Devereaux¹

Affiliations

Affiliation

¹ From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach).

PMID: 29806816
PMCID: PMC5973906
DOI: 10.1503/cjs.010217

Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost-consequence analysis

Giovanna Lurati Buse et al. Can J Surg. 2018 Jun.

. 2018 Jun;61(3):185-194.

doi: 10.1503/cjs.010217.

Authors

Affiliation

¹ From the University Hospital of Düsseldorf, Düsseldorf, Germany (Lurati Buse); the University Hospital of Basel, Basel, Switzerland (Lurati Buse); the University of Calgary, Calgary, Alta. (Manns); McMaster University, Hamilton, Ont. (Lamy, Guyatt, Tiboni, Devereaux); the Hospital de Clínicas de Porto Alegre, Universidade Federal de Rio Grande do Sul, Brazil (Polanczyk); the Chinese University of Hong Kong, Sha Tin, NT, Hong Kong (Chan); the University of Malaya, Kuala Lampur, Malaysia (Wang); the Fundación Cardioinfantil - Instituto de Cardiología, Bogotá and Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia (Villar); St. John's Medical College and Research Institute, Bangalore, India (Sigamani); the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (Sessler); the HCor Research Institute (Hospital do CoraÇão), São Paulo, Brazil (Berwanger); the Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (Biccard); Barts and The London School of Medicine and Dentistry, London, UK (Pearse); the Hospital de Sant Pau, Barcelona, Spain (Urrútia); the Jagiellonian University Medical College, Krakow, Poland (Szczeklik); the Hospital General Universitario Gregorio Marañón, Madrid, Spain (Garutti); the University of Manitoba, Winnipeg, Man. (Srinathan); the Universidad Peruana Cayetano Heredia, Lima, Peru (Malaga); the Christian Medical College, Ludhiana, India (Abraham); the George Institute for Global Health, University of Sydney, Sydney, Australia (Chow); the University of Alberta Hospital, Edmonton, Alta. (Jacka); the University College London, London, UK (Ackland); the London Health Sciences Centre, London, Ont. (Macneil); the University of Leeds, Leeds, UK (Sapsford); the Royal Liverpool Broadgreen University Hospital Trust, Liverpool, UK (Leuwer); and the HÔpital Pitié-Salpêtrière, Paris, France (Le Manach).

PMID: 29806816
PMCID: PMC5973906
DOI: 10.1503/cjs.010217

Abstract
in English, French

Background: Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is strongly associated with 30-day mortality; however, it remains mostly undetected without systematic troponin T monitoring. We evaluated the cost and consequences of postoperative troponin T monitoring to detect MINS.

Methods: We conducted a model-based cost-consequence analysis to compare the impact of routine troponin T monitoring versus standard care (troponin T measurement triggered by ischemic symptoms) on the incidence of MINS detection. Model inputs were based on Canadian patients enrolled in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, which enrolled patients aged 45 years or older undergoing inpatient noncardiac surgery. We conducted probability analyses with 10 000 iterations and extensive sensitivity analyses.

Results: The data were based on 6021 patients (48% men, mean age 65 [standard deviation 12] yr). The 30-day mortality rate for MINS was 9.6%. We determined the incremental cost to avoid missing a MINS event as $1632 (2015 Canadian dollars). The cost-effectiveness of troponin monitoring was higher in patient subgroups at higher risk for MINS, e.g., those aged 65 years or more, or with a history of atherosclerosis or diabetes ($1309).

Conclusion: The costs associated with a troponin T monitoring program to detect MINS were moderate. Based on the estimated incremental cost per health gain, implementation of postoperative troponin T monitoring seems appealing, particularly in patients at high risk for MINS.

Contexte: Les lésions myocardiques après chirurgie non cardiaque (CNC) sont majoritairement asymptomatiques et fortement associées au risque de mortalité dans les 30 jours; toutefois, dans la plupart des cas, elles ne sont pas détectées en l'absence d'une surveillance systématique de la troponine T. Nous avons évalué les coûts et les conséquences d'une telle surveillance pour détecter les lésions myocardiques après CNC.

Méthodes: Nous avons mené une analyse coût-conséquence modélisée pour comparer la surveillance systématique de la troponine T aux soins habituels seuls (mesure de la troponine T seulement s'il y a présence de symptômes d'ischémie) sur la fréquence de détection de lésions myocardiques après CNC. Les données ayant servi à l'analyse provenaient des patients canadiens ayant participé à l'étude de cohorte VISION, qui visait à évaluer les complications vasculaires chez les patients de 45 ans et plus ayant subi une CNC. Nous avons mené des analyses de probabilité avec 10 000 itérations et des analyses de sensibilité approfondies.

Résultats: Les données portaient sur 6021 patients (48 % du sexe masculin; âge moyen de 65 ans [écart-type de 12 ans]). Le taux de mortalité dans les 30 jours associé à une lésion myocardique après CNC était de 9,6 %. Nous avons déterminé que le coût marginal de la détection de la présence d'une lésion par surveillance de la troponine T était de 1632 $ (dollars canadiens en 2015). Le rapport coût-efficacité était plus bas pour les sous-groupes de patients à risque élevé de lésion myocardique après CNC, comme les patients de 65 ans et plus ou ceux ayant des antécédents d'athérosclérose ou de diabète (1309 $), que pour leurs pairs.

Conclusion: Les coûts associés à un programme de surveillance de la troponine T pour détecter les lésions myocardiques après CNC étaient modérés. Le coût marginal estimé par gain de santé indique que la mise en œuvre de ce type de programme pourrait être une option intéressante, surtout pour les patients à risque élevé de lésion myocardique après CNC.

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Conflict of interest statement

Competing interests: Roche Diagnostics provided the troponin T assays and financial support for the VISION study. P. Devereaux has received other funding from Roche Diagnostics and Abbott Diagnostics for investigator-initiated studies. No other competing interests declared.

Figures

**Fig. 1**
Flow chart showing selection of study population. Note: VISION = Vascular Events in Noncardiac Surgery Patients Cohort Evaluation.

**Fig. 2**
Decision tree representing the alternatives and the health states at the end of the monitoring period. Note: MINS = myocardial injury after noncardiac surgery.

See this image and copyright information in PMC

References

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1. Botto F, Alonso-Coello P, Chan MT, et al. Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Writing Group, on behalf of The Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) Investigators. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014;120:564–78. - PubMed
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Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost-consequence analysis

Affiliation

Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost-consequence analysis

Authors

Affiliation

Abstract
in English, French

Conflict of interest statement

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References

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Medical

Abstract in English, French

Conflict of interest statement

Figures

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Abstract
in English, French