Key result
Preoperative hs-cTnI predicted 30-day major cardiac complications better than hs-cTnT in vascular surgery (AUC 0.67 vs 0.59; P=0.012), with similar performance in non-vascular surgery.
Why the study?
Does preoperative hs-cTnI compared to hs-cTnT better predict major cardiac complications in patients undergoing non-cardiac surgery?
Cohort (n=1,022)
Blinded
Does preoperative hs-cTnI compared to hs-cTnT better predict major cardiac complications in patients undergoing non-cardiac surgery?
Odds Ratio: 1.5 (95% CI 1–2.1)
Preoperative hs-cTnI may offer better predictive accuracy than hs-cTnT for major cardiac complications in patients undergoing vascular surgery, whereas both perform similarly in non-vascular surgery.
Preoperative hs-cTnI may predict complications better than T in vascular surgery; leaves open assay choice for perioperative risk stratification.
BACKGROUND: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. METHODS: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. RESULTS: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns). CONCLUSIONS: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
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Gualandro et al. (2018) conducted a cohort in Non-cardiac surgery (n=1,022). Preoperative high-sensitivity cardiac troponin I (hs-cTnI) vs. Preoperative high-sensitivity cardiac troponin T (hs-cTnT) was evaluated on Composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days (aOR 1.5, 95% CI 1.0-2.1). Preoperative hs-cTnI predicted 30-day major cardiac complications better than hs-cTnT in vascular surgery (AUC 0.67 vs 0.59; P=0.012), with similar performance in non-vascular surgery.
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