Early elevation in plasma high-sensitivity troponin T and morbidity after elective noncardiac surgery: prospective multicentre observational cohort study

Abstract

Background: Elevated high-sensitivity troponin (hsTnT) after noncardiac surgery is associated with higher mortality, but the temporal relationship between early elevated troponin and the later development of noncardiac morbidity remains unclear. Methods: Prospective observational study of patients aged !45 yr undergoing major noncardiac surgery at four UK hospitals (two masked to hsTnT). The exposure of interest was early elevated troponin, as defined by hsTnT >99th centile (!15 ng L À1) within 24 h after surgery. The primary outcome was morbidity 72 h after surgery, defined by the Postoperative Morbidity Survey (POMS). Secondary outcomes were time to become morbidity-free and ClavieneDindo !grade 3 complications. Results: Early elevated troponin (median 21 ng L À1 [16e32]) occurred in 992 of 4335 (22.9%) patients undergoing elective noncardiac surgery (mean [standard deviation, SD] age, 65 [11] yr; 2385 [54.9%] male). Noncardiac morbidity was more frequent in 494/992 (49.8%) patients with early elevated troponin compared with 1127/3343 (33.7%) patients with hsTnT <99th centile (odds ratio [OR]¼1.95; 95% confidence interval [CI], 1.69e2.25). Patients with early elevated troponin had a higher risk of proven/suspected infectious morbidity (OR¼1.54; 95% CI, 1.24e1.91) and critical care utilisation (OR¼2.05; 95% CI, 1.73e2.43). ClavieneDindo !grade 3 complications occurred in 167/992 (16.8%) patients with early elevated troponin, compared with 319/3343 (9.5%) patients with hsTnT <99th centile (OR¼1.78; 95% CI, 1.48e2.14). Absence of early elevated troponin was associated with morbidity-free recovery (OR¼0.44; 95% CI, 0.39e0.51). Conclusions: Early elevated troponin within 24 h of elective noncardiac surgery precedes the subsequent development of noncardiac organ dysfunction and may help stratify levels of postoperative care in real time.

MicroRNA signatures of perioperative myocardial injury after elective noncardiac surgery: a prospective observational mechanistic cohort study

“…Perioperative myocardial injury (PMI), as defined by elevated plasma troponin after noncardiac surgery, occurs in up to 25% of patients 1 and precedes subsequent noncardiac morbidity. 2 Preoperative computerised tomography coronary angiogram shows that PMI does not appear to be associated with the severity of pre-existing coronary artery disease. 3 These data suggest that there are likely to be several pathophysiologic mechanisms that contribute to asymptomatic elevations in troponin after surgery.…”

High-Sensitivity Cardiac Troponin T Is a Risk Factor for Major Adverse Cardiovascular Events and All-Cause Mortality: A 9.5-Year Follow-Up Study

“…hs-cTnT has been recognized as the first marker of myocardial injury in the diagnosis, risk stratification, and prognosis of an acute coronary syndrome (ACS), and its value has been recognized at home and abroad [ 19 ]. Gareth et al concluded that early elevation in plasma hs-cTnT within 24 h of elective noncardiac surgery precedes the subsequent development of noncardiac organ dysfunction [ 20 ]. Because of its high sensitivity and specificity, hs-cTnT has been agreed upon by the European Heart Association and Chinese experts as the best basis for early diagnosis of acute myocardial infarction (AMI) and risk stratification of heart diseases [ 21 ].…”

High-Sensitivity Cardiac Troponin T is A Risk Factor for Major Adverse Cardiovascular Events&nbsp;and All-Cause Mortality:&nbsp;9.5 Year Follow-up Study

“…hs-cTnT has been recognized as the rst marker of myocardial injury in the diagnosis, risk strati cation and prognosis of acute coronary syndrome (ACS), and its value has been recognized at home and abroad [21]. Gareth L et al concluded that early elevation in plasma hs-cTnT within 24 h of elective noncardiac surgery precedes the subsequent development of noncardiac organ dysfunction [22].Because of its high sensitivity and speci city, hs-cTnT has been agreed upon by the European Heart Association and Chinese experts as the best basis for early diagnosis of acute myocardial infarction (AMI) and risk strati cation of heart diseases [23]. In predicting future events, multiple trials have con rmed an association between elevated hs-cTnT levels and mortality or cardiovascular death in some populations at high risk for cardiovascular disease.…”