Perioperative troponin monitoring in non-cardiac surgery

Objective. To analyze serum troponin I in elective non-cardiac surgery and association of pre- and postoperative levels of this biomarker with cardiovascular complications (CVC) including complications with verified myocardial ischemia. Material and methods. We examined 243 patients aged 66 [60—71] years who underwent elective abdominal and vascular surgery. Serum troponin I of cTnI was analyzed using enzyme-linked immunosorbent assay at two stages: before surgery and the next day after surgery. Logistic regression and ROC-analysis were used. Results. Median levels of enzyme were 0.03 [0.02—0.06] and 0.05 [0.02—0.12] ng/ml at both stages, respectively (p<0.0001). Perioperative CVC occurred in 30 (12.4%) patients, verified myocardial ischemia — in 9 (3.7%) cases. There was no association between preoperative serum troponin I and CVC. Postoperative serum troponin I was associated with CVC (OR 1.91; 95% CI 1.07—3.39; p=0.029), but AUC was only 0.534. Postoperative troponin I was associated with myocardial ischemia (OR 2.75; 95% CI 1.32—5.71; p=0.0067), AUC 0.79, cut-off value >0.1 ng/ml, sensitivity 75%, specificity 73%. Conclusion. Preoperative serum troponin I does not correlate with perioperative CVC. We can clearly talk about correlation between postoperative troponin and complications with verified myocardial ischemia. When using the enzyme-linked immunosorbent assay, the cut-off value was 0.1 ng/ml with high sensitivity and specificity. Thus, diagnostic significance of cTnI monitoring in non-cardiac surgery is beyond doubt.