Key result
Minor elevation of cardiac troponin I below the 99th-percentile URL after noncardiac surgery was associated with increased 30-day mortality compared to no elevation (2.3% vs 0.5%; HR 4.30; P<0.001).
Why the study?
In patients with perioperative cardiac troponin I below the 99th-percentile upper reference limit, mortality according to troponin levels had not been fully evaluated.
Does a minor elevation of postoperative cardiac troponin I below the 99th-percentile upper reference limit increase 30-day mortality in patients undergoing noncardiac surgery?
Cohort (n=5,312)
Does a minor elevation of postoperative cardiac troponin I below the 99th-percentile upper reference limit increase 30-day mortality in patients undergoing noncardiac surgery?
Hazard Ratio: 4.3 (95% CI 2.23–8.29)
Absolute Event Rate: 2.3% vs 0.5%
p-value: p=<0.001
Mild elevations of cardiac troponin I that remain below the 99th-percentile upper reference limit after noncardiac surgery are strongly associated with increased 30-day mortality.
Minor elevations may signal higher risk but should not yet change practice; hypothesis-generating for troponin thresholds post-noncardiac surgery.
BACKGROUND AND OBJECTIVES: In patients with perioperative cardiac troponin (cTn) I below the 99th-percentile upper range of limit (URL), mortality according to cTn I level has not been fully evaluated. This study evaluated the association between postoperative cTn I level above the lowest limit of detection but within the 99th-percentile URL and 30-day mortality after noncardiac surgery. METHODS: Patients with cTn I values below the 99th-percentile URL during the perioperative period were divided into a no-elevation group with cTn I at the lowest limit of detection (6 ng/L) and a minor elevation group with cTn I elevation below the 99th percentile URL (6 ng/L < cTn I < 40 ng/L). The primary outcome was 30-day mortality. RESULTS: Of the 5,312 study participants, 2,582 (48.6%) were included in the no-elevation group and 2,730 (51.4%) were included in the minor elevation group. After propensity score-matching, the minor elevation group showed significantly increased 30-day mortality (0.5% vs. 2.3%; hazard ratio, 4.30; 95% confidence interval, 2.23-8.29; p<0.001). The estimated cutoff value of cTn I to predict 30-day mortality was 6 ng/L with the area under the receiver operating characteristic curve 0.657. CONCLUSIONS: A mild elevation of cTn I within the 99th-percentile URL after noncardiac surgery was significantly associated with increased 30-day mortality as compared with the lowest limit of detection. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0004244.
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Park et al. (2020) conducted a cohort in Noncardiac surgery (n=5,312). Minor elevation of cardiac troponin I (6 to 40 ng/L) vs. No elevation of cardiac troponin I (6 ng/L) was evaluated on 30-day mortality (HR 4.30, 95% CI 2.23-8.29, p=<0.001). Minor elevation of cardiac troponin I below the 99th-percentile URL after noncardiac surgery was associated with increased 30-day mortality compared to no elevation (2.3% vs 0.5%; HR 4.30; P<0.001).
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