A perioperative hs-cTnT delta ≥11ng/l was significantly associated with increased 30- to 365-day all-cause mortality after noncardiac surgery in high-risk patients.
Is a specific threshold of perioperative hs-cTnT delta associated with increased all-cause mortality in patients at elevated cardiovascular risk undergoing noncardiac surgery?
A perioperative hs-cTnT delta of ≥11 ng/l is significantly associated with short- and long-term all-cause mortality after noncardiac surgery, supporting active surveillance and suggesting a potentially lower threshold for defining perioperative myocardial injury.
Abstract Background Perioperative cardiac complications following noncardiac surgery have a high associated morbidity and mortality. Recent guidelines recommend active surveillance using serial high-sensitivity cardiac troponin (hs-cTn) measurements. However, the consensus recommendations regarding the threshold levels of perioperative increase in hs-cTn for the screening target of perioperative myocardial infarction/injury (PMI) range widely. We aimed to evaluate different thresholds associated with postoperative mortality. Methods We undertook a multicenter prospective cohort study involving patients at increased cardiovascular risk undergoing inhospital noncardiac surgery. High-sensitivity cardiac troponin T (hs-cTnT) measurements were obtained prior to surgery and on days 1 and 2 after surgery. Perioperative hs-cTnT delta was defined as difference between preoperative and maximum postoperative hs-cTnT value. We split our cohort according to maximum perioperative hs-cTnT delta into no relevant delta (5ng/l) and all potentially relevant deltas into deciles and evaluated associated all cause mortality at different timepoints from 30 days to 365 days. Results We included 7381 individual patients in our cohort. Of those, 156 patients (2,1%) died within 30 days, and 715 (9.7%) died within 365 days. 4557 patients had a perioperative hs-cTnT delta 5ng/l, the remaining 2824 patients were split into deciles according to their maximum perioperative hs-cTnT-delta. The perioperative hs-cTnT delta associated significantly with all-cause mortality at all timepoints was =11ng/l (Figure). This association was confirmed in multivariable analysis. Conclusion A perioperative hs-cTnT-delta of =11ng/l was associated with short- and longterm all-cause mortality following noncardiac surgery in patients at elevated cardiovascular risk. This confirms the proposed hs-cTnT-delta defining PMI of =14ng/l, but a lower threshold should be further explored.Quantiles association to death at 30 day
Puelacher et al. (2025) studied this question. A perioperative hs-cTnT delta ≥11ng/l was significantly associated with increased 30- to 365-day all-cause mortality after noncardiac surgery in high-risk patients.