P6224Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

Background: Predicting cardiac complications after non-cardiac surgery is challenging. Biomarkers may provide additional information. Purpose: We aimed to compare the accuracy of preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentrations for predicting major cardiac complications after non-cardiac surgery. Methods: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in consecutive patients undergoing two types of non-cardiac surgery: vascular surgery and other non-cardiac surgery. 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. The primary endpoint was a composite of major cardiac complications including myocardial infarction, clinically relevant arrhythmias including cardiac arrest, acute heart failure, and cardiac death within 30 days. Results: Among 707 patients the primary endpoint occurred in 83 (12%) patients, more than four-times more often after vascular surgery (25%) versus other non-cardiac surgery (6%, p<0.01). Among 227 patients undergoing vascular surgery, hs-cTnI but not hs-cTnT was an independent predictor of major cardiac complications [OR 1.5 (95% CI, 1.0–2.3; p=0.046)] and had moderate accuracy. The area under the receiver-operating characteristics curve (AUC) was 0.66 (95% CI, 0.58–0.75) for hs-cTnI versus 0.59 (95% CI, 0.51–0.68; p=0.03) for hs-cTnT. In contrast, among 480 patients undergoing other non-cardiac surgery both hs-cTn I and T were independent predictors of the primary endpoint [OR 1.8 (95% CI, 1.4–2.5; p<0.001) for hs-cTnI and OR 2.9 (95% CI, 1.8–4.8; p<0.001) for hs-cTnT] and showed high accuracy [AUC 0.76 (95% CI, 0.67–0.85) for hs-cTnI and 0.77 (95% CI,0.68–0.86) for hs-cTnT; p=0.85]. Interaction p-values for hs-cTnI and T and type of surgery were 0.017 and 0.006, respectively.