Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

TY - JOUR

T1 - Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

AU - Gualandro, Danielle M

AU - Puelacher, Christian

AU - LuratiBuse, Giovanna

AU - Lampart, Andreas

AU - Strunz, Celia

AU - Cardozo, Francisco A

AU - Yu, Pai C

AU - Jaffe, Allan S

AU - Barac, Sanela

AU - Bock, Lukas

AU - Badertscher, Patrick

AU - du Fay de Lavallaz, Jeanne

AU - Marbot, Stella

AU - Sazgary, Lorraine

AU - Bolliger, Daniel

AU - Rentsch, Katharina

AU - Twerenbold, Raphael

AU - Hammerer-Lercher, Angelika

AU - Melo, Edielle S

AU - Calderaro, Daniela

AU - Duarte, Alberto Js

AU - de Luccia, Nelson

AU - Caramelli, Bruno

AU - Mueller, Christian

AU - TropoVasc and BASEL-PMI Investigators

N1 - Copyright © 2018 Elsevier, Inc. All rights reserved.

PY - 2018/9

Y1 - 2018/9

N2 - BACKGROUND: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery.METHODS: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery.RESULTS: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns).CONCLUSIONS: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.

AB - BACKGROUND: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery.METHODS: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery.RESULTS: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns).CONCLUSIONS: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.

KW - Aged

KW - Biomarkers/blood

KW - Brazil/epidemiology

KW - Coronary Angiography

KW - Echocardiography

KW - Electrocardiography

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Immunoassay

KW - Incidence

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Myocardial Perfusion Imaging

KW - Postoperative Complications/blood

KW - Predictive Value of Tests

KW - ROC Curve

KW - Retrospective Studies

KW - Surgical Procedures, Operative/adverse effects

KW - Survival Rate/trends

KW - Switzerland/epidemiology

KW - Time Factors

KW - Troponin I/blood

KW - Troponin T/blood

U2 - 10.1016/j.ahj.2018.06.012

DO - 10.1016/j.ahj.2018.06.012

M3 - SCORING: Journal article

C2 - 30041065

VL - 203

SP - 67

EP - 73

JO - AM HEART J

JF - AM HEART J

SN - 0002-8703

ER -