Key result
Peak postoperative high-sensitivity troponin I ≥75 ng/L was associated with a >5-fold increased risk of 30-day MACE compared to levels <75 ng/L (9% vs 1%; aHR 5.76, 95% CI 3.64-9.11).
Why the study?
MINS defined by troponin T is associated with perioperative MACE, but hsTnI thresholds associated with 30-day MACE after non-cardiac surgery had not been established.
Does a peak postoperative high-sensitivity troponin I (hsTnI) ≥75 ng/L predict 30-day major adverse cardiovascular events in patients ≥45 years undergoing non-cardiac surgery?
Cohort (n=4,553)
Does a peak postoperative high-sensitivity troponin I (hsTnI) ≥75 ng/L predict 30-day major adverse cardiovascular events in patients ≥45 years undergoing non-cardiac surgery?
Hazard Ratio: 5.76 (95% CI 3.64–9.11)
Absolute Event Rate: 9% vs 1%
A peak postoperative hsTnI ≥75 ng/L strongly predicts 30-day major adverse cardiovascular events after non-cardiac surgery and can be used to diagnose myocardial injury after non-cardiac surgery (MINS).
hsTnI ≥75 ng/L may flag high 30-day MACE risk after noncardiac surgery; leaves open optimal thresholds for clinical adoption pending validation.
BACKGROUND: Myocardial injury after non-cardiac surgery (MINS), based on measurement of troponin T, is associated with perioperative major adverse cardiovascular events (MACE). We therefore determined the high-sensitivity troponin I (hsTnI) thresholds associated with 30 day MACE after non-cardiac surgery. METHODS: We performed a nested biobank cohort study of 4553 patients from the Vascular Events in Non-Cardiac Surgery Patients Cohort Evaluation (VISION) Study. We measured hsTnI (ADVIA Centaur® hsTnI assay) on postoperative days 1 to 3 in patients ≥45 years undergoing non-cardiac surgery. An iterative Cox proportional hazard model determined peak postoperative hsTnI thresholds independently associated with MACE (i.e., death, myocardial infarction occurring on postoperative day 4 or after, non-fatal cardiac arrest, or congestive heart failure) within 30 days after surgery. RESULTS: MACE occurred in 89/4545 (2.0%) patients. Peak hsTnI values of <75 ng/L, 75 ng/L to <1000 ng/L, and ≥1000 ng/L were associated with 1.2% (95% CI, 0.9-1.6), 7.1% (95% CI, 4.8-10.5), and 25.9% (95% CI, 16.3-38.4) MACE, respectively. Compared to peak hsTnI <75 ng/L, values 75 ng/L to <1000 ng/L and ≥1000 ng/L were associated with adjusted hazard ratios (aHR) of 4.53 (95% CI, 2.75-7.48) and 16.17 (95% CI, 8.70-30.07), respectively. MACE was observed in 9% of patients with peak hsTnI ≥75 ng/L vs 1% in patients with peak hsTnI <75 ng/L (aHR 5.76; 95% CI, 3.64-9.11). A peak hsTnI ≥75 ng/L was associated with MACE in the presence (aHR 9.35; 95% CI, 5.28-16.55) or absence (aHR 3.99; 95% CI, 2.19-7.25) of ischemic features of myocardial injury. CONCLUSION: A peak postoperative hsTnI ≥75 ng/L was associated with >5-fold increase in the risk of 30 days MACE compared to levels <75 ng/L. This threshold could be used for MINS diagnosis when the ADVIA Centaur hsTnI assay is used.Clinicaltrials.gov Registration Number: NCT00512109.
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Borges et al. (2023) conducted a cohort in Non-cardiac surgery (n=4,553). Peak postoperative high-sensitivity troponin I (hsTnI) ≥75 ng/L vs. Peak hsTnI <75 ng/L was evaluated on 30-day major adverse cardiovascular events (MACE: death, myocardial infarction, non-fatal cardiac arrest, or congestive heart failure) (aHR 5.76, 95% CI 3.64-9.11). Peak postoperative high-sensitivity troponin I ≥75 ng/L was associated with a >5-fold increased risk of 30-day MACE compared to levels <75 ng/L (9% vs 1%; aHR 5.76, 95% CI 3.64-9.11).
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