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Comparative Study
. 2018 Sep:203:67-73.
doi: 10.1016/j.ahj.2018.06.012. Epub 2018 Jul 5.

Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

Danielle M Gualandro  1 , Christian Puelacher  2 , Giovanna LuratiBuse  3 , Andreas Lampart  4 , Celia Strunz  5 , Francisco A Cardozo  6 , Pai C Yu  6 , Allan S Jaffe  7 , Sanela Barac  2 , Lukas Bock  2 , Patrick Badertscher  2 , Jeanne du Fay de Lavallaz  2 , Stella Marbot  2 , Lorraine Sazgary  2 , Daniel Bolliger  4 , Katharina Rentsch  8 , Raphael Twerenbold  9 , Angelika Hammerer-Lercher  10 , Edielle S Melo  6 , Daniela Calderaro  6 , Alberto Js Duarte  11 , Nelson de Luccia  12 , Bruno Caramelli  6 , Christian Mueller  2 ; TropoVasc and BASEL-PMI Investigators
Affiliations
Comparative Study

Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

Danielle M Gualandro et al. Am Heart J. 2018 Sep.

Abstract

Background: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery.

Methods: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery.

Results: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns).

Conclusions: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.

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