High-sensitivity cardiac troponin T in prediction and diagnosis of myocardial infarction and long-term mortality after noncardiac surgery

Nägele, Peter; Brown, Frank; Gage, Brian F.; Gibson, David W.; Miller, J. Philip; Jaffe, Allan S.; Apple, Fred S.; Scott, Mitchell G.

doi:10.1016/j.ahj.2013.04.018

Cited by 151 publications

(145 citation statements)

References 28 publications

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“…27) Many trials have sought prognosticating factors in noncardiac surgery. 4,5,6,10,21,22,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] In these studies, poor functional capacity, recent MI and unstable angina, decompensated heart failure, significant arrhythmia, diabetes mellitus, renal insufficiency, cerebrovascular disease, advanced age, tachycardia, anemia, surgical kind, and elevated troponin-I level were determined to be independent prognostic factors after noncardiac surgery, most of which were in agreement with our study. While the results of those studies had been generated after short-term follow-up, the present study extended the follow-up period to 7 years and attempted to provide valuable data regarding longer term mortality.…”

Section: )supporting

confidence: 78%

“…6,15,19) The present cohort study estimated the incidence of troponin-I elevation after major noncardiac surgery, and troponin-I positivity above 0.10 ng/mL was found in 12.2% of the patients. Studies with vascular and other highrisk but elective surgery showed an incidence of postoperative troponin elevation of 10 to 45 percent.…”

Section: )mentioning

confidence: 99%

“…13,14) In previous studies, abnormal levels of cardiac biomarkers were proven to be statistically significant independent predictors of intermediate and long-term outcomes of cardiac events. 4,6,[8][9][10] Our study showed that a postoperative troponin-I level above 0.10 ng/mL was an independent factor for long-term mortality. It is notable that there were significant differences between the TnP and TnN groups in the rate of all-cause death until 6 months.…”

Section: )mentioning

confidence: 99%

“…In addition, patients with preexisting troponin-I elevations were excluded, because all-cause mortality can be influenced by myocardial injury which may already have occurred before major noncardiac surgery. 6) Therefore, the present study focused on postoperative troponin-I at higher levels, and could exclude the effect of preexisting troponin-I elevations.…”

Section: )mentioning

confidence: 99%

“…[3][4][5] Many previous studies have investigated the role of cardiac troponins in the diagnosis of perioperative myocardial ischemic events and demonstrated the prognostic value of postoperative cardiac troponin elevation. [6][7][8][9] A recent metaanalysis of studies in predominantly high-risk surgery patients also showed that cardiac troponin elevation was a strong independent predictor of mortality within the first year after surgery. 10…”

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confidence: 99%

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Troponin-I Level After Major Noncardiac Surgery and Its Association With Long-Term Mortality

et al. 2016

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SummaryIndividuals with intermediate to high cardiac risk for major noncardiac surgery suffer from perioperative myocardial ischemic injury. The purpose of this study was to evaluate the long-term impact of postoperative cardiac troponin elevation on clinical outcome after major noncardiac surgery.Patients (n = 750) aged ≥ 50 years who underwent major noncardiac surgery were eligible for the study. Postoperative cardiac troponin-I data were collected retrospectively and consecutively. The primary outcome measure was allcause mortality. The median follow-up period was 1727 days in all patients.Among 750 patients, 92 (12.2%) showed elevated postoperative troponin-I above 0.10 ng/mL. Operative mortality was 4.1% (31 subjects), and patients with troponin-I elevation showed a higher operative mortality rate (RR: 4.23, 95% CI: 2.67-11.31, P < 0.001). In multivariate Cox regression analysis, a troponin-I concentration above 0.10 ng/mL was associated with all-cause mortality (RR: 1.73, 95% CI: 1.27-2.36, P < 0.001). It should be noted that there was a significant difference between patients with elevated and non-elevated troponin-I in the rate of mortality until 6 months. However, these differences disappeared after 6 months. An elevated troponin-I level conferred an increase in mortality during the 7 year follow-up period after major noncardiac surgery. This difference in mortality was mainly derived from the result within the first 6 months. (Int Heart J 2016; 57: 278-284) Key words: Myocardial ischemia, Death, Surgical procedures A ll surgical procedures elicit a stress response, although the extent of the response depends on the extent of the surgery and the use of anesthetics and analgesics that are used to reduce the response. The stress response can lead to increases in heart rate and blood pressure, which can precipitate episodes of myocardial ischemia. 1)Individuals with intermediate to high cardiac risk for noncardiac surgery suffer from perioperative myocardial ischemic injury.2) Cardiac troponins are a useful tool that help clinicians in making the diagnosis of perioperative myocardial infarction.3-5) Many previous studies have investigated the role of cardiac troponins in the diagnosis of perioperative myocardial ischemic events and demonstrated the prognostic value of postoperative cardiac troponin elevation.6-9) A recent metaanalysis of studies in predominantly high-risk surgery patients also showed that cardiac troponin elevation was a strong independent predictor of mortality within the first year after surgery. 10) Editorial p.265The development of perioperative cardiovascular complications not only affects the short-term period prognosis but may also influence the long-term consequences. However, few studies have explored the long-term, defined as beyond the first year after major noncardiac surgery, prognostic value of cardiac troponin elevation in the prediction of postoperative outcome. We undertook this study to evaluate the clinical outcome of cardiac troponin elevation after major noncardiac sur...

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