Perioperative myocardial injury with normal preoperative hs-cTnT and perioperative elevation was associated with a high 3-year risk of MACCE compared to no elevation (adjusted OR 3.5; 95% CI 2.0-5.9).
Observational (n=1,290)
Does the timing of perioperative myocardial injury (PMI) based on hs-cTnT elevation predict long-term MACCE and mortality in patients aged ≥50 years undergoing major noncardiac surgery?
Perioperative increases in hs-cTnT, regardless of preoperative levels, are associated with a sustained high risk of MACCE up to 3 years after major noncardiac surgery.
Effect estimate: adjusted OR 3.5 (95% CI 2.0-5.9)
Absolute Event Rate: 45.2% vs 17.1%
Background: Perioperative myocardial injury (PMI) is associated with increased short-term major adverse cardio- and cerebrovascular events (MACCE) and mortality. We evaluated how different phenotypes of PMI based on timing of injury impact long-term MACCE and mortality among patients undergoing major noncardiac surgery (NCS). Methods: A prospective, observational study was carried out in 1290 patients aged ≥50 yr undergoing major noncardiac surgery. High-sensitivity cardiac troponin T (hs-cTnT) was measured before surgery and up to 3 days after surgery. Patients were classified into four groups: (1) no hs-cTnT elevation, (2) isolated preoperative hs-cTnT increases, (3) normal preoperative hs-cTnT with perioperative elevation, and (4) increased preoperative hs-cTnT with perioperative elevation. The main outcomes were MACCE and mortality up to 3 yr after operation. Results: At 3-yr follow-up, MACCE had occurred in 17.1%, 37.9%, 45.2%, and 50.7% and mortality was 21.4%, 30.3%, 30.1%, and 33.8% in groups 1-4, respectively. All PMI phenotypes were independently associated with MACCE. Patients with 'normal preoperative hs-cTnT with perioperative elevation' appeared to have the highest risk. In this phenotype, the risk was greatest at 30 days (adjusted odds ratio, 4.5; 95% confidence interval, 2.3-8.8) and persisted over 3 yr (adjusted odds ratio, 3.5; 95% confidence interval, 2.0-5.9). PMI was associated with increased mortality, but the relationship was not sustained after multivariable adjustment. Conclusions: Increased hs-cTnT based on timing identifies prognostically important subgroups. Perioperative increases, regardless of preoperative levels, are associated with a high risk of MACCE that is sustained up to 3 yr after surgery. This supports the use of time-based PMI phenotypes for prognostic enrichment studies to mitigate the risk of MACCE. Clinical trial registration: NCT03436238.
Fält et al. (Sun,) conducted a observational in Major noncardiac surgery (n=1,290). Perioperative myocardial injury (PMI) phenotypes vs. No hs-cTnT elevation was evaluated on Major adverse cardio- and cerebrovascular events (MACCE) up to 3 years (adjusted OR 3.5, 95% CI 2.0-5.9). Perioperative myocardial injury with normal preoperative hs-cTnT and perioperative elevation was associated with a high 3-year risk of MACCE compared to no elevation (adjusted OR 3.5; 95% CI 2.0-5.9).
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