BACKGROUND: Perioperative myocardial infarction (MI) is a serious complication after noncardiac surgery. We hypothesized that preoperative cardiac troponin T detected with a novel high-sensitivity (hs-cTnT) assay will identify patients at risk for acute MI and long-term mortality after major noncardiac surgery. METHODS: This was a prospective cohort study within the VINO trial (n = 608). Patients had been diagnosed with or had multiple risk factors for coronary artery disease and underwent major noncardiac surgery. Cardiac troponin I (contemporary assay) and troponin T (high-sensitivity assay) and 12-lead electrocardiograms were obtained before and immediately after surgery and on postoperative days 1, 2, and 3. RESULTS: At baseline before surgery, 599 patients (98.5%) had a detectable hs-cTnT concentration, and 247 (41%) were >14 ng/L (99th percentile). After surgery, 497 patients (82%) had a rise in hs-cTnT (median change in hs-cTnT +2.7 ng/L [interquartile range 0.7-6.8]). During the first 3 postoperative days, there were 9 patients (2.5%) with a preoperative hs-cTnT <14 ng/L with acute MI, compared with 21 patients (8.6%) with a preoperative hs-cTnT >14 ng/L (odds ratio 3.67, 95% CI 1.65-8.15). During long-term follow-up, 80 deaths occurred. The 3-year mortality rate was 11% in patients with a preoperative hs-cTnT concentration <14 ng/L compared with 25% in patients with a preoperative hs-cTnT >14 ng/L (adjusted hazard ratio 2.17, 95% CI 1.19-3.96). CONCLUSIONS: In this cohort of high-risk patients, preoperative hs-cTnT concentrations were significantly associated with postoperative MI and long-term mortality after noncardiac surgery.
BACKGROUND: Perioperative myocardial infarction (MI) is a serious complication after noncardiac surgery. We hypothesized that preoperative cardiac troponin T detected with a novel high-sensitivity (hs-cTnT) assay will identify patients at risk for acute MI and long-term mortality after major noncardiac surgery. METHODS: This was a prospective cohort study within the VINO trial (n = 608). Patients had been diagnosed with or had multiple risk factors for coronary artery disease and underwent major noncardiac surgery. Cardiac troponin I (contemporary assay) and troponin T (high-sensitivity assay) and 12-lead electrocardiograms were obtained before and immediately after surgery and on postoperative days 1, 2, and 3. RESULTS: At baseline before surgery, 599 patients (98.5%) had a detectable hs-cTnT concentration, and 247 (41%) were >14 ng/L (99th percentile). After surgery, 497 patients (82%) had a rise in hs-cTnT (median change in hs-cTnT +2.7 ng/L [interquartile range 0.7-6.8]). During the first 3 postoperative days, there were 9 patients (2.5%) with a preoperative hs-cTnT <14 ng/L with acute MI, compared with 21 patients (8.6%) with a preoperative hs-cTnT >14 ng/L (odds ratio 3.67, 95% CI 1.65-8.15). During long-term follow-up, 80 deaths occurred. The 3-year mortality rate was 11% in patients with a preoperative hs-cTnT concentration <14 ng/L compared with 25% in patients with a preoperative hs-cTnT >14 ng/L (adjusted hazard ratio 2.17, 95% CI 1.19-3.96). CONCLUSIONS: In this cohort of high-risk patients, preoperative hs-cTnT concentrations were significantly associated with postoperative MI and long-term mortality after noncardiac surgery.
Authors: Christopher R deFilippi; James A de Lemos; Robert H Christenson; John S Gottdiener; Willem J Kop; Min Zhan; Stephen L Seliger Journal: JAMA Date: 2010-11-15 Impact factor: 56.272
Authors: P J Devereaux; Denis Xavier; Janice Pogue; Gordon Guyatt; Alben Sigamani; Ignacio Garutti; Kate Leslie; Purnima Rao-Melacini; Sue Chrolavicius; Homer Yang; Colin Macdonald; Alvaro Avezum; Luc Lanthier; Weijiang Hu; Salim Yusuf Journal: Ann Intern Med Date: 2011-04-19 Impact factor: 25.391
Authors: Evangelos Giannitsis; Kerstin Kurz; Klaus Hallermayer; Jochen Jarausch; Allan S Jaffe; Hugo A Katus Journal: Clin Chem Date: 2009-12-03 Impact factor: 8.327
Authors: Torbjørn Omland; James A de Lemos; Marc S Sabatine; Costas A Christophi; Madeline Murguia Rice; Kathleen A Jablonski; Solve Tjora; Michael J Domanski; Bernard J Gersh; Jean L Rouleau; Marc A Pfeffer; Eugene Braunwald Journal: N Engl J Med Date: 2009-11-25 Impact factor: 91.245
Authors: J E Adams; G S Bodor; V G Dávila-Román; J A Delmez; F S Apple; J H Ladenson; A S Jaffe Journal: Circulation Date: 1993-07 Impact factor: 29.690
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Anne Ruth Bass; Tomás Rodriguez; Gina Hyun; Francisco Gerardo Santiago; Jacqueline Ilji Kim; Scott Christopher Woller; Brian Foster Gage Journal: Int Orthop Date: 2015-07-09 Impact factor: 3.075
Authors: A Duma; C Wagner; M Titz; M Maleczek; M Hüpfl; V B Weihs; E Samaha; H Herkner; T Szekeres; M Mittlboeck; M G Scott; A S Jaffe; P Nagele Journal: Br J Anaesth Date: 2017-12-05 Impact factor: 9.166
Authors: Lee A Fleisher; Kirsten E Fleischmann; Andrew D Auerbach; Susan A Barnason; Joshua A Beckman; Biykem Bozkurt; Victor G Davila-Roman; Marie D Gerhard-Herman; Thomas A Holly; Garvan C Kane; Joseph E Marine; M Timothy Nelson; Crystal C Spencer; Annemarie Thompson; Henry H Ting; Barry F Uretsky; Duminda N Wijeysundera Journal: J Nucl Cardiol Date: 2015-02 Impact factor: 5.952
Authors: Andreas Duma; Swatilika Pal; Joshua Johnston; Mohammad A Helwani; Adithya Bhat; Bali Gill; Jessica Rosenkvist; Christopher Cartmill; Frank Brown; J Philip Miller; Mitchell G Scott; Francisco Sanchez-Conde; Michael Jarvis; Nuri B Farber; Charles F Zorumski; Charles Conway; Peter Nagele Journal: Anesthesiology Date: 2017-04 Impact factor: 7.892
Authors: M Melanie Lyons; Nitin Y Bhatt; Elizabeth Kneeland-Szanto; Brendan T Keenan; Joanne Pechar; Branden Stearns; Nabil M Elkassabany; Stavros G Memtsoudis; Allan I Pack; Indira Gurubhagavatula Journal: Biomark Med Date: 2016 Impact factor: 2.851
Authors: Eslam Samaha; Mohammad A Helwani; Jamie C Brown; Frank Brown; Allan S Jaffe; Mitchell G Scott; Peter Nagele Journal: Clin Biochem Date: 2017-11-22 Impact factor: 3.281
Authors: Peter Nagele; Frank Brown; Amber Francis; Mitchell G Scott; Brian F Gage; J Philip Miller Journal: Anesthesiology Date: 2014-02 Impact factor: 7.892
Authors: Michael Kopec; Andreas Duma; Mohammad A Helwani; Jamie Brown; Frank Brown; Brian F Gage; David W Gibson; J Philip Miller; Eric Novak; Allan S Jaffe; Fred S Apple; Mitchell G Scott; Peter Nagele Journal: Anesth Analg Date: 2017-02 Impact factor: 5.108
Authors: Felix Kork; Felix Balzer; Claudia D Spies; Klaus-Dieter Wernecke; Adit A Ginde; Joachim Jankowski; Holger K Eltzschig Journal: Anesthesiology Date: 2015-12 Impact factor: 7.892