Clinical Use of Ultrasensitive Cardiac Troponin I Assay in Intermediate- and High-Risk Surgery Patients

Abstract

Background. Cardiac troponin levels have been reported to add value in the detection of cardiovascular complications in noncardiac surgery. A sensitive cardiac troponin I (cTnI) assay could provide more accurate prognostic information. Methods. This study prospectively enrolled 142 patients with at least one Revised Cardiac Risk Index risk factor who underwent noncardiac surgery. cTnI levels were measured postoperatively. Short-term cardiac outcome predictors were evaluated. Results. cTnI elevation was observed in 47 patients, among whom 14 were diagnosed as having myocardial infarction (MI). After 30 days, 16 patients had major adverse cardiac events (MACE). Excluding patients with a final diagnosis of MI, predictors of cTnI elevation included dialysis, history of heart failure, transoperative major bleeding, and elevated levels of pre- and postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP). Maximal cTnI values showed the highest sensitivity (94%), specificity (75%), and overall accuracy (AUC 0.89; 95% CI 0.80–0.98) for postoperative MACE. Postoperative cTnI peak level (OR 9.4; 95% CI 2.3–39.2) and a preoperative NT-proBNP level ≥917 pg/mL (OR 3.47; 95% CI 1.05–11.6) were independent risk factors for MACE. Conclusions. cTnI was shown to be an independent prognostic factor for cardiac outcomes and should be considered as a component of perioperative risk assessment.

KCNQ1OT1, HIF1A‐AS2 and APOA1‐AS are promising novel biomarkers for diagnosis of coronary artery disease

“…The combination of these three lncRNAs enhanced the specificity and sensitivity to diagnose CAD. For years, NT‐proBNP, CKMB, MYO or HsTnT have been proposed to be the diagnostic criteria for CAD . Logistic regression analysis indicated that these lncRNAs are cooperative predictive biomarkers for CAD: APOA1‐AS was associated with NT‐proBNP, CKMB, MYO and HsTnT; and HIF1A‐AS2 was associated with NT‐proBNP and NT‐proBNP.…”

Evaluation of Perioperative High-Sensitive Cardiac Troponin I as a Predictive Biomarker of Major Adverse Cardiovascular Events After Noncardiac Surgery

“…Our findings suggest that elevated PreOp hs-cTnI concentrations in patients with cardiovascular risk factors are independently associated to the development of MACE and death. Borges et al reported that a peak level of PostOp hs-cTnI > 40 pg/ml was associated to decreased survival and decreased event-free survival by day 30 14 . Likewise, a greater increase in the PreOp and PostOp Δ hs-cTn is associated with a greater incidence of the analyzed outcomes 5,[15][16][17][18] .…”

Sleep Apnea in Total Joint Arthroplasty Patients and the Role for Cardiac Biomarkers for Risk Stratification: an Exploration of Feasibility

“…Most of the studies that have investigated the role of perioperative measurement of cTns evaluated patients undergoing noncardiac surgery, rather than solely on TJA, and were assessing for myocardial injury [23,26,28] and infarction [21][22][23][24][25][26][27] (see Table 1). These studies have a great deal of heterogeneity in the specific assays and timing of troponin measurement, as well as specific populations within the larger grouping of noncardiac surgery.…”

“…Other studies have found increased levels of cTnI or cTnT (including hs-cTnT), drawn preoperation and or for any of the first three mornings postoperation [21,[23][24]26,28,32], or for at least two consecutive days postoperation [22,25,34] were helpful in identifying risk for postoperative cardiac complications for up to 1 month [23,[25][26][28][29]], 1 year [32] and up to 5 years [21,24,34] following surgery. In addition to increased postoperative morbidity, both cTnI and cTnT or hs-cTnT have been associated with identifying increased risk of mortality.…”