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High-Sensitivity Cardiac Troponin I Thresholds to Identify Myocardial Injury After Noncardiac Surgery: A Cohort Study.
- Source :
-
The Canadian journal of cardiology [Can J Cardiol] 2023 Mar; Vol. 39 (3), pp. 311-318. Date of Electronic Publication: 2023 Jan 20. - Publication Year :
- 2023
-
Abstract
- Background: Myocardial injury after noncardiac surgery (MINS) is common and associated with short- and long-term major cardiovascular events. Diagnostic criteria for MINS using Abbott high-sensitivity cardiac troponin I (hs-cTnI) are unknown.<br />Methods: We performed a prospective cohort study of adults who had in-patient noncardiac surgery and measured hs-cTnI (Abbott Laboratories) on postoperative serum samples collected up to postoperative day 3. The objective was to determine prognostically important hs-cTnI thresholds associated with major cardiac events and death at 30 days after noncardiac surgery. Using Cox proportional iterative analyses, we determined peak postoperative hs-cTnI thresholds associated with the occurrence of the 30-day composite of major cardiac events (ie, nonfatal myocardial infarction after 3 postoperative days, cardiac arrest, and congestive heart failure) and death.<br />Results: Of 3953 included patients, 66 (1.7%) experienced the primary outcome at 30 days. Peak hs-cTnI values and associated incidence of major cardiac events and death were as follows: < 60 ng/L: 1.0% (95% CI 0.7-1.3); 60 to < 700 ng/L: 8.6% (5.6-13.0); and ≥ 700 ng/L: 27.3% (16.4-41.9). Compared with peak hs-cTnI < 60 ng/L, adjusted hazard ratios were 7.54 (95% CI% 4.27-13.32) for hs-cTnI values of 60 to < 700 ng/L and 26.87 (13.27-54.41) for values ≥ 700 ng/L.<br />Conclusions: Hs-cTnI elevation within the first 3 days after noncardiac surgery independently predicts major cardiac events and death at 30 days. A postoperative hs-cTnI ≥ 60 ng/L was associated with a > 7-fold increase in the risk of subsequent major cardiac events and mortality at 30 days.<br /> (Copyright © 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1916-7075
- Volume :
- 39
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The Canadian journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 36682485
- Full Text :
- https://doi.org/10.1016/j.cjca.2023.01.008