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Canadian Journal of Cardiology

High-Sensitivity Cardiac Troponin I thresholds to identify myocardial injury after noncardiac surgery: a cohort study

Published:January 19, 2023DOI:https://doi.org/10.1016/j.cjca.2023.01.008

      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.

      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 (i.e., non-fatal myocardial infarction after 3 days postoperative, cardiac arrest, and congestive heart failure) and death.

      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% (95% CI 5.6-13.0); and ≥700 ng/L, 27.3% (95% CI 16.4-41.9). Compared to peak hs-cTnI <60 ng/L, adjusted hazard ratios (aHR) were 7.54 (95% CI% 4.27-13.32) for hs-cTnI values of 60 to <700 ng/L and 26.87 (95% CI 13.27-54.41) for values ≥700 ng/L.

      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.

      Graphical abstract

      KEYWORDS

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