Author(s): Nagele P, Brown F, Gage BF, Gibson DW, Miller JP,
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Abstract BACKGROUND: Perioperative myocardial infarction (MI) is a serious complication after noncardiac surgery. We hypothesized that preoperative cardiac troponin T detected with a novel high-sensitivity (hs-cTnT) assay will identify patients at risk for acute MI and long-term mortality after major noncardiac surgery. METHODS: This was a prospective cohort study within the VINO trial (n = 608). Patients had been diagnosed with or had multiple risk factors for coronary artery disease and underwent major noncardiac surgery. Cardiac troponin I (contemporary assay) and troponin T (high-sensitivity assay) and 12-lead electrocardiograms were obtained before and immediately after surgery and on postoperative days 1, 2, and 3. RESULTS: At baseline before surgery, 599 patients (98.5\%) had a detectable hs-cTnT concentration, and 247 (41\%) were >14 ng/L (99th percentile). After surgery, 497 patients (82\%) had a rise in hs-cTnT (median change in hs-cTnT +2.7 ng/L [interquartile range 0.7-6.8]). During the first 3 postoperative days, there were 9 patients (2.5\%) with a preoperative hs-cTnT <14 ng/L with acute MI, compared with 21 patients (8.6\%) with a preoperative hs-cTnT >14 ng/L (odds ratio 3.67, 95\% CI 1.65-8.15). During long-term follow-up, 80 deaths occurred. The 3-year mortality rate was 11\% in patients with a preoperative hs-cTnT concentration <14 ng/L compared with 25\% in patients with a preoperative hs-cTnT >14 ng/L (adjusted hazard ratio 2.17, 95\% CI 1.19-3.96). CONCLUSIONS: In this cohort of high-risk patients, preoperative hs-cTnT concentrations were significantly associated with postoperative MI and long-term mortality after noncardiac surgery. Copyright © 2013 Mosby, Inc. All rights reserved.
This article was published in Am Heart J
and referenced in Angiology: Open Access