Identification of myocardial injury using perioperative troponin surveillance in major noncardiac surgery and net benefit over the Revised Cardiac Risk Index.

Aged Cohort Studies Elective Surgical Procedures / methods Female Heart Injuries / epidemiology Humans Male Middle Aged Perioperative Period Postoperative Complications / epidemiology Prognosis Prospective Studies Risk Assessment Sweden Troponin T / metabolism

MACCE MINS biomarker cardiac troponins high-sensitivity cardiac troponin T major adverse cardiovascular and cerebrovascular events myocardial injury perioperative surgery

Journal

British journal of anaesthesia

ISSN: 1471-6771

Titre abrégé: Br J Anaesth

Pays: England

ID NLM: 0372541

Informations de publication

Date de publication:
Jan 2022

Historique:

received: 20 03 2021

revised: 12 09 2021

accepted: 05 10 2021

pubmed: 4 12 2021

medline: 17 2 2022

entrez: 3 12 2021

Statut: ppublish

Résumé

Patients with perioperative myocardial injury are at risk of death and major adverse cardiovascular and cerebrovascular events (MACCE). The primary aim of this study was to determine optimal thresholds of preoperative and perioperative changes in high-sensitivity cardiac troponin T (hs-cTnT) to predict MACCE and mortality. Prospective, observational, cohort study in patients ≥50 yr of age undergoing elective major noncardiac surgery at seven hospitals in Sweden. The exposures were hs-cTnT measured before and days 0-3 after surgery. Two previously published thresholds for myocardial injury and two thresholds identified using receiver operating characteristic analyses were evaluated using multivariable logistic regression models and externally validated. The weighted comparison net benefit method was applied to determine the additional value of hs-cTnT thresholds when compared with the Revised Cardiac Risk Index (RCRI). The primary outcome was a composite of 30-day all-cause mortality and MACCE. We included 1291 patients between April 2017 and December 2020. The primary outcome occurred in 124 patients (9.6%). Perioperative increase in hs-cTnT ≥14 ng L Perioperative increases in hsTnT ≥14 ng L NCT03436238.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Prospective, observational, cohort study in patients ≥50 yr of age undergoing elective major noncardiac surgery at seven hospitals in Sweden. The exposures were hs-cTnT measured before and days 0-3 after surgery. Two previously published thresholds for myocardial injury and two thresholds identified using receiver operating characteristic analyses were evaluated using multivariable logistic regression models and externally validated. The weighted comparison net benefit method was applied to determine the additional value of hs-cTnT thresholds when compared with the Revised Cardiac Risk Index (RCRI). The primary outcome was a composite of 30-day all-cause mortality and MACCE.

RESULTS RESULTS

We included 1291 patients between April 2017 and December 2020. The primary outcome occurred in 124 patients (9.6%). Perioperative increase in hs-cTnT ≥14 ng L

CONCLUSIONS CONCLUSIONS

Perioperative increases in hsTnT ≥14 ng L

CLINICAL TRIAL REGISTRATION BACKGROUND

NCT03436238.

Identifiants

DOI: 10.1016/j.bja.2021.10.006 PMID: 34857357

pubmed: 34857357

pii: S0007-0912(21)00649-8

doi: 10.1016/j.bja.2021.10.006

pii:

doi:

Substances chimiques

Troponin T 0

Banques de données

ClinicalTrials.gov

['NCT03436238']

Types de publication

Journal Article Multicenter Study Observational Study Validation Study

Langues

eng

Sous-ensembles de citation

Pagination

26-36