Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery
Standard
Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery. / Gualandro, Danielle M; Puelacher, Christian; LuratiBuse, Giovanna; Lampart, Andreas; Strunz, Celia; Cardozo, Francisco A; Yu, Pai C; Jaffe, Allan S; Barac, Sanela; Bock, Lukas; Badertscher, Patrick; du Fay de Lavallaz, Jeanne; Marbot, Stella; Sazgary, Lorraine; Bolliger, Daniel; Rentsch, Katharina; Twerenbold, Raphael; Hammerer-Lercher, Angelika; Melo, Edielle S; Calderaro, Daniela; Duarte, Alberto Js; de Luccia, Nelson; Caramelli, Bruno; Mueller, Christian; TropoVasc and BASEL-PMI Investigators.
In: AM HEART J, Vol. 203, 09.2018, p. 67-73.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
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 -