Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery

Devereaux, P.J.; Biccard, Bruce; Sigamani, Alben; Xavier, Denis; Chan, Matthew T. V.; Srinathan, Sadeesh; Walsh, Michael; Abraham, Valsa; Pearse, Rupert M; Wang, C. Y.; Sessler, Daniel I.; Kurz, Andrea; Szczeklik, Wojciech; Berwanger, Otávio; Villar, Juan Carlos; Málaga, Germán; Garg, Amit X.; Chow, Clara K; Ackland, Gareth L.; Patel, Ameen; Borges, Flávia Kessler; Belley‐Côté, Emilie P.; Duceppe, Emmanuelle; Spence, Jessica; Tandon, Vikas; Williams, Colin; Sapsford, Robert J; Polanczyk, Carísi Anne; Tiboni, Maria; Alonso‐Coello, Pablo; Faruqui, Atiya; Heels‐Ansdell, Diane; Lamy, André; Whitlock, Richard; LeManach, Yannick; Roshanov, Pavel S; McGillion, Michael; Kavsak, Peter A.; McQueen, Matthew; Thabane, Lehana; Rodseth, Reitze; Buse, Giovanna Lurati; Bhandari, Mohit; Garutti, Ignacio; Jacka, Michael J.; Schünemann, Holger J.; Cortés, Olga; Coriat, Pierre; Dvirnik, Nazari; Botto, Fernando; Pettit, Shirley; Jaffe, Allan S.; Guyatt, Gordon

doi:10.1001/jama.2017.4360

Cited by 599 publications

(447 citation statements)

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“…The current study showed that the rate of acute coronary syndrome with any revascularization was lower than 0.2% in the patients who underwent non-cardiac surgery. 29 Because of the small sample size in our study, it is not unreasonable that there were no cases of cardiac death or myocardial infarction.…”

Section: Discussionmentioning

confidence: 72%

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery

Toda

Nakamura

Nakagawa

et al. 2018

Circ J

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Section: Discussionmentioning

confidence: 72%

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery

Toda

Nakamura

Nakagawa

et al. 2018

Circ J

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“…[1][2][3][4][5] In contrast with spontaneous myocardial infarction (MI), PMI most commonly does not exhibit typical symptoms of myocardial ischemia, such as chest pain, angina pectoris, or dyspnea, and is therefore missed in routine clinical practice in most institutions in the United States and worldwide. [1][2][3][4][5] Considering that >300 million surgeries are performed annually and that demographic change is resulting in an increasing number of surgical patients with elevated cardiovascular risk, strategies to improve the detection, treatment, and outcome of PMI may have the potential to provide major medical benefits. A missed diagnosis inevitably leads to a missed chance for treatment.…”

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confidence: 99%

Perioperative Myocardial Injury After Noncardiac Surgery

et al. 2018

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1 ORIGINAL RESEARCH ARTICLE ORIGINAL RESEARCH ARTICLEEditorial, see p XXX BACKGROUND: Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening. METHODS:We performed a prospective diagnostic study enrolling consecutive patients undergoing noncardiac surgery who had a planned postoperative stay of ≥24 hours and were considered at increased cardiovascular risk. All patients received a systematic screening using serial measurements of high-sensitivity cardiac troponin T in clinical routine. PMI was defined as an absolute high-sensitivity cardiac troponin T increase of ≥14 ng/L from preoperative to postoperative measurements. Furthermore, mortality was compared among patients with PMI not fulfilling additional criteria (ischemic symptoms, new ECG changes, or imaging evidence of loss of viable myocardium) required for the diagnosis of spontaneous acute myocardial infarction versus those that did. RESULTS:From 2014 to 2015 we included 2018 consecutive patients undergoing 2546 surgeries. Patients had a median age of 74 years and 42% were women. PMI occurred after 397 of 2546 surgeries (16%; 95% confidence interval, 14%-17%) and was accompanied by typical chest pain in 24 of 397 patients (6%) and any ischemic symptoms in 72 of 397 (18%). Crude 30-day mortality was 8.9% (95% confidence interval [CI], 5.7-12.0) in patients with PMI versus 1.5% (95% CI, 0.9-2.0) in patients without PMI (P<0.001). Multivariable regression analysis showed an adjusted hazard ratio of 2.7 (95% CI, 1.5-4.8) for 30-day mortality. The difference was retained at 1 year with mortality rates of 22.5% (95% CI, 17.6-27.4) versus 9.3% (95% CI, 7.9-10.7). Thirty-day mortality was comparable among patients with PMI not fulfilling any other of the additional criteria required for spontaneous acute myocardial infarction (280/397, 71%) versus those with at least 1 additional criterion (10.4%; 95% CI, versus 8.7%; 95% CI, P=0.684). CONCLUSIONS:PMI is a common complication after noncardiac surgery and, despite early detection during routine clinical screening, is associated with substantial short-and long-term mortality. Mortality seems comparable in patients with PMI not fulfilling any other of the additional criteria required for spontaneous acute myocardial infarction versus those patients who do. CLINICAL TRIAL REGISTRATION: Perioperative myocardial injury (PMI) has recently been identified as an important, yet often undetected complication after noncardiac surgery, strongly associated with 30-day mortality. [1][2][3][4][5] In contrast with spontaneous myocardial infarction (MI), PMI most commonly does not exhibit typical symptoms of myocardial ischemia, such as chest pain, angina pectoris, or dyspnea, and is therefore missed in routine clinical practice in most institutions in the United States and worldwide. [1][2][3][4][5] Considering that >300 million surgeries are performed annually and that de...

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“…Among them, cardiac risk index (CRI) is the most commonly used (4). However, despite a good preoperative risk stratification, some patients still present a MI or a myocardial infarction (1,5). As nearly 60% of myocardial infarction are asymptomatic the diagnosis of these events is often difficult (1).…”

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confidence: 99%

“…Twenty-nine centers in 15 countries included approximately 40,000 patients aged from 45 years and older were between 2007 and 2013. Using the VISION cohort, several reports have been published during last years which studied diagnostic criteria, risk scoring systems and prognosis of MINS (1,5,(9)(10)(11)(12). A particular interest of the VISION investigators was to determine a prognostic value of TnT level (5,11).…”

mentioning

confidence: 99%

“…Using the VISION cohort, several reports have been published during last years which studied diagnostic criteria, risk scoring systems and prognosis of MINS (1,5,(9)(10)(11)(12). A particular interest of the VISION investigators was to determine a prognostic value of TnT level (5,11). The first results of this work concerning prognostic value of the fourth-generation measurement of non-high sensitivity troponin T (nonhsTnT) level were published in 2012 in a previous issue of the JAMA (3).…”

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confidence: 99%

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Post-operative high sensitivity troponin T (hsTnT): toward an extending use for diagnosis and management of myocardial injury after noncardiac surgery?

Chapalain¹,

Huet²

2017

J. Thorac. Dis.

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Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery

Abstract: Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.

Cited by 599 publications

References 14 publications

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery

Perioperative Myocardial Injury After Noncardiac Surgery

Post-operative high sensitivity troponin T (hsTnT): toward an extending use for diagnosis and management of myocardial injury after noncardiac surgery?

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