Why the study?
Although raised preoperative high-sensitivity troponin is frequently detected before major non-cardiac surgery, its prognostic value in predicting postoperative outcomes remained unclear.
Does preoperative high-sensitivity cardiac troponin measurement improve prediction of postoperative major adverse cardiac events and mortality in patients undergoing major non-cardiac surgery?
Does preoperative high-sensitivity cardiac troponin measurement improve prediction of postoperative major adverse cardiac events and mortality in patients undergoing major non-cardiac surgery?
Raised preoperative high-sensitivity troponin improves cardiovascular risk discrimination for postoperative MACE and mortality compared to Lee's Revised Cardiac Risk Index alone in non-cardiac surgery patients.
May enhance perioperative risk stratification in noncardiac surgery; meta-analysis of observational data leaves open prospective validation and outcome impact.
BACKGROUND: Patients undergoing major non-cardiac surgery are at risk of cardiovascular complications. Raised levels of high-sensitivity troponin are frequently detected before operation among these patients. However, the prognostic value of high-sensitivity troponin in predicting postoperative outcomes remains unclear. METHODS: A systematic search of PubMed, Embase and Science Citation Index Expanded was undertaken for observational studies published before March 2018 that reported associations between raised preoperative levels of high-sensitivity troponin and postoperative major adverse cardiac events and/or mortality after non-cardiac surgery. Meta-analyses were performed, where possible, using random-effects models. RESULTS: = 74·2 per cent). The addition of preoperative high-sensitivity troponin measurement provided improvements in cardiovascular risk discrimination (increase in C-index ranged from 0·058 to 0·109) and classification (quantified by continuous net reclassification improvement) compared with Lee's Revised Cardiac Risk Index alone. There was substantial heterogeneity and inadequate risk stratification analysis in the included studies. CONCLUSION: Raised preoperative levels of high-sensitivity troponin appear to represent a risk for postoperative major adverse cardiac events and mortality. Further study is required before high-sensitivity troponin can be used to predict risk stratification in routine clinical practice.
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Zhao et al. (2020) studied this question.