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September 10, 2026Journal of the American Heart Association0 citationsOpen Access

Comparison of Preoperative Troponin T and NT-proBNP for Risk Prediction in Noncardiac Surgery

Comparison of High‐Sensitivity Troponin T Versus N‐Terminal Pro‐B‐Type Natriuretic Peptide for Prediction of Major Adverse Cardiovascular Events After Noncardiac Surgery

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Why the study?

Does preoperative hs-TnT compared to NT-proBNP improve the prediction of 30-day major adverse cardiovascular events and death in patients with elevated cardiovascular risk undergoing elective noncardiac surgery?

Population

2,251 patients with elevated cardiovascular risk undergoing elective noncardiac surgery

Comparison

Preoperative high-sensitivity cardiac troponin T… vs Preoperative N-terminal pro-B-type natriuretic…

Design

Cohort

Follow-up

30-day

Key result

Preoperative hs-TnT and NT-proBNP provided limited improvement in predicting 30-day MACE (5.8% overall incidence) over RCRI and age, with no significant difference between the biomarkers.

Authors

AKAnna KirkopoulosJLJan LarmannHGH Gillmann

Discussion

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Overview

Preoperative hs-TnT and NT-proBNP are both associated with postoperative MACE and death, but provide limited incremental predictive value over clinical risk scores (RCRI and age) with no significant difference between the two biomarkers.

Key Points

  • To directly compare the performance of preoperative high-sensitivity cardiac troponin T (hs-TnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) for predicting 30-day major adverse cardiovascular events and mortality after noncardiac surgery.
  • Conducted a pooled secondary analysis of 2251 patients with elevated cardiovascular risk undergoing elective noncardiac surgery from the METREPAIR and MINSS studies.
  • Evaluated multivariable logistic regression models combining the Revised Cardiac Risk Index (RCRI) and age with each biomarker using receiver operating characteristic curves, calibration slopes, Brier scores, and decision curve analysis.
  • In the cohort of 2251 patients, 30-day major adverse cardiovascular events occurred in 5.8% (131/2251) and 30-day mortality occurred in 1.6% (37/2251).
  • Both biomarkers significantly correlated with outcomes, but only hs-TnT modestly improved discrimination for mortality (AUC 0.680 for RCRI+age+hs-TnT vs 0.674 for RCRI+age; ΔAUC: 0.006; P=0.047), while neither substantially improved prediction for major adverse cardiovascular events.
  • Decision curve analysis showed negligible differences in net benefit between hs-TnT and NT-proBNP across predefined risk thresholds, confirming limited incremental value over RCRI and age.

Study Design

Type

Cohort (n=2,251)

Multicenter

Yes

Structured PICO

Does preoperative hs-TnT compared to NT-proBNP improve the prediction of 30-day major adverse cardiovascular events and death in patients with elevated cardiovascular risk undergoing elective noncardiac surgery?

P
Population
2,251 patients with elevated cardiovascular risk undergoing elective noncardiac surgery, evaluated for 30-day major adverse cardiovascular events.
E
Exposure
Preoperative high-sensitivity cardiac troponin T (hs-TnT) measurement
C
Comparator
Preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement
O
Outcome
Incidence of 30-day major adverse cardiovascular events (MACE)composite

Preoperative hs-TnT and NT-proBNP are both associated with postoperative MACE and death, but provide limited incremental predictive value over clinical risk scores (RCRI and age) with no significant difference between the two biomarkers.

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Cite This Study

Kirkopoulos et al. (2026) conducted a cohort in Elevated cardiovascular risk undergoing elective noncardiac surgery (n=2,251). Preoperative hs-TnT and NT-proBNP vs. Revised Cardiac Risk Index (RCRI) and age alone was evaluated on 30-day major adverse cardiovascular events. Preoperative hs-TnT and NT-proBNP provided limited improvement in predicting 30-day MACE (5.8% overall incidence) over RCRI and age, with no significant difference between the biomarkers.

synapsesocial.com/papers/6aa27b6f58559d80afc74a86https://doi.org/10.1161/jaha.126.050032
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