High-sensitivity cardiac troponin T in prediction and diagnosis of myocardial infarction and long-term mortality after noncardiac surgery

Abstract

Background Perioperative myocardial infarction is a serious complication after non-cardiac surgery. We hypothesized that preoperative cardiac troponin T detected with a novel high-sensitivity (hs-cTnT) assay will identify patients at risk of acute myocardial infarction (AMI) and long-term mortality after major non-cardiac surgery. Methods This was a prospective cohort study within the Vitamins in Nitrous Oxide (VINO) trial (n=608). Patients had been diagnosed with or had multiple risk factors for coronary artery disease and underwent major non-cardiac 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 day 1, 2 and 3. Results At baseline before surgery, 599 patients (98.5%) had a detectable hs-cTnT concentration and 247 (41%) were above 14 ng/L (99th percentile). After surgery, 497 patients (82%) had a rise in hs-cTnT (median Δhs-cTnT +2.7 ng/L [IQR 0.7, 6.8]). During the first three postoperative days, 9 patients (2.5%) with a preoperative hs-cTnT <14 ng/L suffered from AMI, compared to 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 to 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 myocardial infarction and long-term mortality after non-cardiac surgery.