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Borges F, Duceppe E, Heels-Ansdell D, Ofori S, Marcucci M, Kavsak P, Pettit S, Spence J, Belley-Cote E, Lemanach Y, McGillion M, Whitlock R, Lamy A, Devereaux P. High-sensitivity troponin I predicts major cardiovascular events after noncardiac surgery. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocardial injury after noncardiac surgery (MINS) is common and is associated with postoperative major cardiac events and 30-day mortality. We have previously established the diagnostic criteria for MINS with the 4th-generation cardiac troponin T assay (TnT) and 5th-generation high-sensitivity TnT assay (hsTnT) based on prognostically relevant thresholds. Little is known about diagnostic criteria for MINS using the high-sensitivity troponin I (hsTnI) assay.
Purpose
To determine hsTnI thresholds associated with 30-day major cardiac events and death after noncardiac surgery.
Methods
We performed a nested prospective biobank cohort study of 4545 patients from the VISION Study. Patients were aged ≥45 years and underwent in-patient noncardiac surgery under regional or general anesthesia. Patients had samples collected and frozen preoperatively, and on postoperative days 1, 2 and 3. We measured hsTnI on thawed preoperative and postoperative samples. We used iterative Cox proportional hazard models to determine peak postoperative hsTnI thresholds independently associated with major cardiac events (i.e., composite of death, non-fatal cardiac arrest, congestive heart failure within 30 days and non-fatal myocardial infarction from postoperative days 4–30).
Results
Major cardiac events occurred in 89/4545 (2.0%) patients. Peak hsTnI values of <75 ng/L, 75 ng/L to <1000 ng/L, and ≥1000 ng/L were associated with an incidence of major cardiac events of 1.2% (95% CI 0.9–1.6), 7.1% (95% CI 4.8–10.5) and 25.9% (95% CI 16.3–38.4), respectively. Compared to peak hsTnI <75 ng/L (reference), hsTnI values 75 ng/L to <1000 ng/L and ≥1000 ng/L were associated with adjusted hazard ratios (aHR) of 4.53 (95% CI 2.75–7.48) and 16.17 (95% CI 8.70–30.07), respectively. No change from preoperative hsTnI to peak postoperative hsTnI significantly improved the model when included on top of the identified thresholds. Incidence of major cardiac events was 31/343 (9%) in patients with postoperative peak hsTnI ≥75 ng/L versus 52/4178 (1%) in patients with postoperative peak hsTnI <75 ng/L (aHR 5.76; 95% CI 3.64–9.11). A postoperative peak hsTnI ≥75 ng/L was associated with increased risk of major cardiac events either in the presence (aHR 9.35; 95% CI 5.28–16.55) or absence (aHR 3.99; 95% CI 2.19–7.25) of clinical features of myocardial injury (e.g., chest pain, ischemic electrocardiography changes).
Conclusion
A hsTnI elevation within the first 3 days after noncardiac surgery independently predicts major cardiac events at 30 days. A peak postoperative hsTnI ≥75 ng/L was associated with a 6-fold increase in the risk of subsequent major cardiac events at 30 days as compared to peak postoperative hsTnI<75 ng/L. This hsTnI threshold can be used to diagnose MINS.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Siemens Healthcare Diagnostics Inc. Canadian Institutes of Health Research
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Affiliation(s)
| | - E Duceppe
- University of Montreal, Montreal, Canada
| | | | - S.N Ofori
- McMaster University, Hamilton, Canada
| | | | | | - S Pettit
- McMaster University, Hamilton, Canada
| | - J Spence
- McMaster University, Hamilton, Canada
| | | | | | | | | | - A Lamy
- McMaster University, Hamilton, Canada
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Grammatico-Guillon L, Hermetet C, Lemanach Y, Gaborit C, Laporte L, Guillon A. Devenir à long terme des personnes âgées hospitalisées en réanimation pour infection respiratoire aiguë. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Spence J, Belley-Cote E, Jacobsohn E, Syed S, Whitlock R, Lee SF, Bangdiwala S, Arora R, Sarkaria A, MacIsaac S, Girling L, Lemanach Y, Lamy A, Devereaux PJ, Connolly S. P836Benzodiazepine-free cardiac anesthesia for reduction of delirium (B-Free): a two-centre pilot study to determine the feasibility of a multi-centre, randomized, cluster crossover trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Spence
- Population Health Research Institute, Perioperative Medicine and Surgical Research Group, Hamilton, Canada
| | - E Belley-Cote
- Population Health Research Institute, Perioperative Medicine and Surgical Research Group, Hamilton, Canada
| | - E Jacobsohn
- St. Boniface General Hospital, Department of Anesthesia, Winnipeg, Canada
| | - S Syed
- McMaster University, Department of Anesthesia, Hamilton, Canada
| | - R Whitlock
- Population Health Research Institute, Perioperative Medicine and Surgical Research Group, Hamilton, Canada
| | - S F Lee
- Population Health Research Institute, Hamilton, Canada
| | - S Bangdiwala
- Population Health Research Institute, Hamilton, Canada
| | - R Arora
- Institute of Cardiovascular Sciences, Department of Surgery, Section of Cardiac Surgery, Winnipeg, Canada
| | - A Sarkaria
- Population Health Research Institute, Hamilton, Canada
| | - S MacIsaac
- Population Health Research Institute, Hamilton, Canada
| | - L Girling
- St. Boniface General Hospital, Department of Anesthesia, Winnipeg, Canada
| | - Y Lemanach
- McMaster University, Department of Anesthesia, Hamilton, Canada
| | - A Lamy
- Population Health Research Institute, Hamilton, Canada
| | - P J Devereaux
- Population Health Research Institute, Perioperative Medicine and Surgical Research Group, Hamilton, Canada
| | - S Connolly
- Population Health Research Institute, Hamilton, Canada
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