High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery

Noordzij, Peter G.; Geffen, O. van; Dijkstra, Ineke M.; Boerma, Djamila; Meinders, Antje; Rettig, Thijs C D; Eefting, Frank D.; Loon, Douwe van; Garde, E.M.W. van de; Dongen, E.P.A. van

doi:10.1093/bja/aev027

Cited by 86 publications

(71 citation statements)

References 27 publications

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“…These findings extend and corroborate previous work on PMI and efforts aimed at improving outcomes after noncardiac surgery 1,2,[4][5][6]19 The high incidence of PMI and the high mortality rate observed in this study suggest that the specific selection criteria used to identify high-risk patients deserve to be replicated in future studies. Ideally, these should include a randomized controlled trial testing the effect of active surveillance combined with an active response protocol on clinical and economic outcomes.…”

supporting

confidence: 90%

“…PMI is a common complication after noncardiac surgery and, despite early detection during routine clini- (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) 1261 (51) 18 1626 (64) 3 (1)(2)(3)(4)(5)(6)(7)(8) No PMI 12 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) 957 (46) 15 (10)(11)(12)(13)(14)(15)(16)(17)(...…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the definition of PMI, the high frequency of elevated hs-cTn plasma concentrations before surgery observed in this study (51%), VISION, and other studies clearly highlight the need for a definition that takes preoperative hs-cTn levels into consideration to avoid misclassification of chronic hs-cTn elevations as PMI. 4,5,9,19 Second, clinical presentation of PMI differed markedly from that of spontaneous AMI. 8 Among patients with PMI, only 6% had typical chest pain, 18% had any ischemic symptoms, and 29% fulfilled additional criteria required for spontaneous AMI beyond the increase in hs-cTnT.…”

Section: Discussionmentioning

confidence: 99%

“…PMI incidence differed in patients treated on the surgical ward, patients staying in the ICU for a short period, and patients with prolonged stay (≥2 days), with 13% (95% CI, [12][13][14][15]19% (95% CI,[15][16][17][18][19][20][21][22][23], and 56% (95% CI, 46-65), respectively.…”

Section: Incidence Of Pmimentioning

confidence: 99%

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Perioperative Myocardial Injury After Noncardiac Surgery

et al. 2018

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1 ORIGINAL RESEARCH ARTICLE ORIGINAL RESEARCH ARTICLEEditorial, see p XXX BACKGROUND: Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening. METHODS:We performed a prospective diagnostic study enrolling consecutive patients undergoing noncardiac surgery who had a planned postoperative stay of ≥24 hours and were considered at increased cardiovascular risk. All patients received a systematic screening using serial measurements of high-sensitivity cardiac troponin T in clinical routine. PMI was defined as an absolute high-sensitivity cardiac troponin T increase of ≥14 ng/L from preoperative to postoperative measurements. Furthermore, mortality was compared among patients with PMI not fulfilling additional criteria (ischemic symptoms, new ECG changes, or imaging evidence of loss of viable myocardium) required for the diagnosis of spontaneous acute myocardial infarction versus those that did. RESULTS:From 2014 to 2015 we included 2018 consecutive patients undergoing 2546 surgeries. Patients had a median age of 74 years and 42% were women. PMI occurred after 397 of 2546 surgeries (16%; 95% confidence interval, 14%-17%) and was accompanied by typical chest pain in 24 of 397 patients (6%) and any ischemic symptoms in 72 of 397 (18%). Crude 30-day mortality was 8.9% (95% confidence interval [CI], 5.7-12.0) in patients with PMI versus 1.5% (95% CI, 0.9-2.0) in patients without PMI (P<0.001). Multivariable regression analysis showed an adjusted hazard ratio of 2.7 (95% CI, 1.5-4.8) for 30-day mortality. The difference was retained at 1 year with mortality rates of 22.5% (95% CI, 17.6-27.4) versus 9.3% (95% CI, 7.9-10.7). Thirty-day mortality was comparable among patients with PMI not fulfilling any other of the additional criteria required for spontaneous acute myocardial infarction (280/397, 71%) versus those with at least 1 additional criterion (10.4%; 95% CI, versus 8.7%; 95% CI, P=0.684). CONCLUSIONS:PMI is a common complication after noncardiac surgery and, despite early detection during routine clinical screening, is associated with substantial short-and long-term mortality. Mortality seems comparable in patients with PMI not fulfilling any other of the additional criteria required for spontaneous acute myocardial infarction versus those patients who do. CLINICAL TRIAL REGISTRATION: Perioperative myocardial injury (PMI) has recently been identified as an important, yet often undetected complication after noncardiac surgery, strongly associated with 30-day mortality. [1][2][3][4][5] In contrast with spontaneous myocardial infarction (MI), PMI most commonly does not exhibit typical symptoms of myocardial ischemia, such as chest pain, angina pectoris, or dyspnea, and is therefore missed in routine clinical practice in most institutions in the United States and worldwide. [1][2][3][4][5] Considering that >300 million surgeries are performed annually and that de...

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supporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Incidence Of Pmimentioning

confidence: 99%

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Perioperative Myocardial Injury After Noncardiac Surgery

et al. 2018

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“…24 Noordzij et al suggested that a relative change in hs-cTnT >50% from baseline value seemed to be appropriate for diagnosis of myocardial injury. 21 Eggers et al tested the best cutoff value to diagnose acute myocardial infarction among changes in hs-cTnT ≥20%, ≥50%, or ≥100% from baseline. They found that a change >50% was associated with the most frequent false-negative results in diagnosing acute myocardial infarction.…”

Section: Incidence Of Composite Of In-hospital Cardiovascular Eventsmentioning

confidence: 99%