Key result
Perioperative myocardial infarction/injury diagnosed by high-sensitivity cardiac troponin I occurred in 9% of patients and was associated with a significantly increased risk of 30-day mortality (HR 6.2) compared to patients without injury.
Why the study?
While perioperative myocardial infarction/injury diagnosed by hs-cTnT is frequent and prognostically important after non-cardiac surgery, the incidence and outcomes of PMI diagnosed using hs-cTnI compared with hs-cTnT required evaluation.
Does the diagnosis of perioperative myocardial infarction/injury using hs-cTnI compared to hs-cTnT affect the incidence and prognostic value for mortality in high cardiovascular risk patients undergoing non-cardiac surgery?
Cohort (n=2,455)
Yes
Does the diagnosis of perioperative myocardial infarction/injury using hs-cTnI compared to hs-cTnT affect the incidence and prognostic value for mortality in high cardiovascular risk patients undergoing non-cardiac surgery?
Hazard Ratio: 6.2 (95% CI 4–11)
Absolute Event Rate: 9% vs 1%
p-value: p=<0.001
PMI diagnosed by hs-cTnI is less common than by hs-cTnT, but both remain strong independent predictors of 30-day and 1-year mortality after non-cardiac surgery.
Background Perioperative myocardial infarction/injury (PMI) diagnosed by high-sensitivity troponin (hs-cTn) T is frequent and a prognostically important complication of non-cardiac surgery. We aimed to evaluate the incidence and outcome of PMI diagnosed using hs-cTnI, and compare it to PMI diagnosed using hs-cTnT. Methods We prospectively included 2455 patients at high cardiovascular risk undergoing 3111 non-cardiac surgeries, for whom hs-cTnI and hs-cTnT concentrations were measured before surgery and on postoperative days 1 and 2. PMI was defined as a composite of perioperative myocardial infarction (PMIInfarct) and perioperative myocardial injury (PMIInjury), according to the Fourth Universal Definition of Myocardial Infarction. All-cause mortality was the primary endpoint. Results Using hs-cTnI, the incidence of overall PMI was 9% (95% confidence interval [CI] 8–10%), including PMIInfarct 2.6% (95% CI 2.0–3.2) and PMIInjury 6.1% (95% CI 5.3–6.9%), which was lower versus using hs-cTnT: overall PMI 15% (95% CI 14–16%), PMIInfarct 3.7% (95% CI 3.0–4.4) and PMIInjury 11.3% (95% CI 10.2–12.4%). All-cause mortality occurred in 52 (2%) patients within 30 days and 217 (9%) within 1 year. Using hs-cTnI, both PMIInfarct and PMIInjury were independent predictors of 30-day all-cause mortality (adjusted hazard ratio [aHR] 2.5 [95% CI 1.1–6.0], and aHR 2.8 [95% CI 1.4–5.5], respectively) and, 1-year all-cause mortality (aHR 2.0 [95% CI 1.2–3.3], and aHR 1.8 [95% CI 1.2–2.7], respectively). Overall, the prognostic impact of PMI diagnosed by hs-cTnI was comparable to the prognostic impact of PMI using hs-cTnT. Conclusions Using hs-cTnI, PMI is less common versus using hs-cTnT. Using hs-cTnI, both PMIInfarct and PMIInjury remain independent predictors of 30-day and 1-year mortality. Graphic abstract
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Gualandro et al. (2021) conducted a cohort in Perioperative myocardial infarction/injury (PMI) in non-cardiac surgery (n=2,455). Perioperative myocardial infarction/injury (PMI) diagnosed by hs-cTnI vs. No PMI was evaluated on 30-day all-cause mortality (HR 6.2, 95% CI 4-11, p=<0.001). Perioperative myocardial infarction/injury diagnosed by high-sensitivity cardiac troponin I occurred in 9% of patients and was associated with a significantly increased risk of 30-day mortality (HR 6.2) compared to patients without injury.
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