Key result
Peak postoperative TnT hs Gen 6 of 45 to <140 ng/L and ≥140 ng/L increased 30-day death or MACE vs <45 ng/L (aHR 3.99, 95% CI 2.12-7.50; and aHR 20.06, 95% CI 11.21-35.90).
Why the study?
Myocardial injury after noncardiac surgery is associated with increased risk of death and MACE, motivating the determination and external validation of 6th generation high-sensitivity cardiac troponin T thresholds associated with 30-day death or MACE.
Does a peak postoperative 6th generation high-sensitivity cardiac troponin T threshold of ≥ 45 ng/L identify an increased risk of 30-day death or major cardiovascular events in patients undergoing noncardiac surgery?
Cohort (n=4,275)
Does a peak postoperative 6th generation high-sensitivity cardiac troponin T threshold of ≥ 45 ng/L identify an increased risk of 30-day death or major cardiovascular events in patients undergoing noncardiac surgery?
A peak postoperative 6th generation high-sensitivity troponin T threshold of ≥ 45 ng/L is associated with at least a 4-fold increased risk of 30-day death or MACE after noncardiac surgery and can serve as a diagnostic criterion for myocardial injury after noncardiac surgery (MINS).
Answers are grounded in this paper and cite their sources.
Supports ≥45 ng/L hs-cTnT threshold for postoperative MACE risk stratification after noncardiac surgery; extends MINS criteria but leaves open whether troponin-guided interventions improve outcomes.
Background Myocardial injury after noncardiac surgery (MINS) is associated with an increased risk of death and major cardiovascular events (MACE). Purpose Our objective was to determine the 6th generation high-sensitivity cardiac troponin T (TnT hs Gen 6) thresholds associated with 30-day death or MACE after noncardiac surgery and externally validate them. Methods We performed a nested VISION biobank cohort study. We measured the TnT hs Gen 6 daily, preoperatively and up to postoperative day 3. An iterative Cox proportional hazard model determined peak postoperative TnT hs Gen 6 thresholds independently associated with the primary outcome. We followed the principles of the Declaration of Helsinki, and all participants provided informed consent. Results The primary outcome occurred in 72/4275 patients (2.0%). Peak TnT hs Gen 6 values of < 45 ng/L, 45 ng/L to < 140 ng/L, and ≥ 140 ng/L demonstrated 30-day incidences of death or MACE of 25/3539 (0.7%), 19/561 (3.4%) and 28/175 (16%), respectively. Compared to peak postoperative TnT hs Gen 6 < 45 ng/L (reference), values from 45 ng/L to < 140 ng/L and ≥ 140 ng/L were independently associated with the primary outcome, with adjusted hazard ratios (aHR) of 3.99 (95% CI, 2.12-7.50) and 20.06 (95% CI, 11.21-35.90), respectively. Participants with peak postoperative TnT hs Gen 6 ≥ 45 ng/L without an ischaemic feature had an aHR of 4.10 (95% CI, 1.89-8.88) for the primary outcome. Validation results in the PMI-VITAL cohort (ClinicalTrials.gov NCT05866874) were consistent. Conclusion A peak postoperative TnT hs Gen 6 threshold ≥ 45ng/L was associated with 4-fold increase in the risk of 30-day death or MACE compared to levels < 45 ng/L. This assay threshold is prognostically relevant and can be used as a diagnostic criterion for MINS. (ClinicalTrials.gov NCT00512109)Picture 1
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Borges et al. (2026) conducted a cohort in Myocardial injury after noncardiac surgery (MINS) (n=4,275). Peak postoperative 6th generation high-sensitivity cardiac troponin T (TnT hs Gen 6) 45 to <140 ng/L and ≥140 ng/L vs. Peak postoperative TnT hs Gen 6 <45 ng/L was evaluated on 30-day death or major cardiovascular events (MACE) (aHR 3.99, 95% CI 2.12-7.50). Peak postoperative TnT hs Gen 6 of 45 to <140 ng/L and ≥140 ng/L increased 30-day death or MACE vs <45 ng/L (aHR 3.99, 95% CI 2.12-7.50; and aHR 20.06, 95% CI 11.21-35.90).
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