Validation of ESC criteria for perioperative myocardial infarction/injury with the new 6th generation high sensitivity cardiac troponin T assay

Background The newly introduced high-sensitivity cardiac troponin T generation 6 (hs-cTnT-gen6) is expected to replace hs-cTnT-gen5, but it is unknown whether established ESC diagnostic criteria for perioperative myocardial infarction/injury (PMI) remain valid. Methods Consecutive patients undergoing major non-cardiac surgery were prospectively included, hs-cTnT-gen6 was measured preoperatively and on postoperative days 1 and 2. PMI was centrally adjudicated and defined according to ESC criteria using an absolute hs-cTnT-gen6 increase ≥27 ng/L between two measurements in the PMI-VITAL cohort (one university hospital in Switzerland). Diagnostic endpoints included the incidence and aetiologies of PMI; the prognostic endpoint was a composite of major adverse cardiac events (MACE) and all-cause mortality, analysed using a Royston–Parmar model with time-varying hazard ratios (HRs). Results 451 patients (median age 72 years; 26% women) were included, PMI occurred in 67 (14.86%) patients, including 61 (91.04%) of cardiac and 6 (9.84%) of extracardiac aetiology (Figure 1). MACE occurred in 9% at 30 days and 23.9% at 1 year of patients with PMI versus 1.3% and 6% of patients without PMI, respectively. All-cause mortality was 7.5% at 30 days and 25.4% at 1 year of patients with PMI versus 0.5% and 6% of patients without PMI, respectively (Figure 2). Adjusted HRs of PMI were 3.24 (95% confidence interval [CI], 1.38-7.6) at 30 days and 4.88 (95% CI, 1.84-13) at 1 year for MACE and all-cause mortality. Conclusions PMI defined by ESC criteria using hs-cTnT-gen6 was common and strongly associated with adverse short- and long-term endpoints, supporting its use in clinical practice.