Key result
Postoperative peak cardiac troponin I levels were an independent risk factor for 30-day major adverse cardiac events in patients undergoing noncardiac surgery (OR 9.4; 95% CI 2.3-39.2).
Why the study?
Does postoperative sensitive cardiac troponin I (cTnI) measurement predict 30-day major adverse cardiac events (MACE) in patients undergoing noncardiac surgery with at least one Revised Cardiac Risk Index risk factor?
Cohort (n=142)
Does postoperative sensitive cardiac troponin I (cTnI) measurement predict 30-day major adverse cardiac events (MACE) in patients undergoing noncardiac surgery with at least one Revised Cardiac Risk Index risk factor?
Odds Ratio: 9.4 (95% CI 2.3–39.2)
Postoperative sensitive cardiac troponin I measurement is an independent prognostic factor for 30-day major adverse cardiac events in intermediate- and high-risk noncardiac surgery patients.
May support postoperative troponin monitoring for risk stratification in intermediate- to high-risk noncardiac surgery; leaves open whether measurement should alter management.
BACKGROUND: Cardiac troponin levels have been reported to add value in the detection of cardiovascular complications in noncardiac surgery. A sensitive cardiac troponin I (cTnI) assay could provide more accurate prognostic information. METHODS: This study prospectively enrolled 142 patients with at least one Revised Cardiac Risk Index risk factor who underwent noncardiac surgery. cTnI levels were measured postoperatively. Short-term cardiac outcome predictors were evaluated. RESULTS: cTnI elevation was observed in 47 patients, among whom 14 were diagnosed as having myocardial infarction (MI). After 30 days, 16 patients had major adverse cardiac events (MACE). Excluding patients with a final diagnosis of MI, predictors of cTnI elevation included dialysis, history of heart failure, transoperative major bleeding, and elevated levels of pre- and postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP). Maximal cTnI values showed the highest sensitivity (94%), specificity (75%), and overall accuracy (AUC 0.89; 95% CI 0.80-0.98) for postoperative MACE. Postoperative cTnI peak level (OR 9.4; 95% CI 2.3-39.2) and a preoperative NT-proBNP level ≥917 pg/mL (OR 3.47; 95% CI 1.05-11.6) were independent risk factors for MACE. CONCLUSIONS: cTnI was shown to be an independent prognostic factor for cardiac outcomes and should be considered as a component of perioperative risk assessment.
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Borges et al. (2013) conducted a cohort in Intermediate- and High-Risk Noncardiac Surgery (n=142). Postoperative cardiac troponin I (cTnI) peak level was evaluated on Major adverse cardiac events (MACE) at 30 days (OR 9.4, 95% CI 2.3-39.2). Postoperative peak cardiac troponin I levels were an independent risk factor for 30-day major adverse cardiac events in patients undergoing noncardiac surgery (OR 9.4; 95% CI 2.3-39.2).