High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
03 03 2022
03 03 2022
Historique:
entrez:
2
3
2022
pubmed:
3
3
2022
medline:
16
3
2022
Statut:
ppublish
Résumé
Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury. (Funded by the Canadian Institutes of Health Research and others; VISION Cardiac Surgery ClinicalTrials.gov number, NCT01842568.).
Sections du résumé
BACKGROUND
Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations.
METHODS
We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex).
RESULTS
Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit.
CONCLUSIONS
The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury. (Funded by the Canadian Institutes of Health Research and others; VISION Cardiac Surgery ClinicalTrials.gov number, NCT01842568.).
Identifiants
pubmed: 35235725
doi: 10.1056/NEJMoa2000803
doi:
Substances chimiques
Biomarkers
0
Troponin I
0
Banques de données
ClinicalTrials.gov
['NCT01842568']
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
827-836Subventions
Organisme : British Heart Foundation
ID : RE/18/5/34216
Pays : United Kingdom
Organisme : British Heart Foundation
ID : FS/16/14/32023
Pays : United Kingdom
Organisme : British Heart Foundation
ID : CH/F/21/90010
Pays : United Kingdom
Investigateurs
Muammar Abdulrahman
(M)
Bashir Muhammadfarrukh
(B)
Mostafa Alwash
(M)
Nooraldeen Al-Mohamadawi
(N)
Rawasi Fakhri
(R)
Paul Hunter
(P)
Andrew Dooley
(A)
John Fedoryshyn
(J)
Steve Ham
(S)
Summer Syed
(S)
Justine Denomme
(J)
John Lee
(J)
Tomas van Helder
(T)
Adel Dyub
(A)
Iqbal Jaffer
(I)
Victor Chu
(V)
Lloyd Semelhago
(L)
Krysten Gregus
(K)
Jacqueline Hare
(J)
Deborah DuMerton
(D)
Jessica M Shelley
(JM)
Emile P Peponoulas
(EP)
OreOluwa Adeyinka
(O)
Logan M Begbie
(LM)
Jordan Dang
(J)
Michael Cummings
(M)
Tarit Saha
(T)
Robert Tanzola
(R)
Louie Wang
(L)
Ramiro Arellano
(R)
David Mark
(D)
Shelly K Au
(SK)
Lilia Kaustov
(L)
Jessica Pacquing
(J)
Kathrina Flores
(K)
Josiane C Mapplebeck
(JC)
Arththi Thanabalasingam
(A)
Vladimir A Boboshko
(VA)
Gleb B Moroz
(GB)
Nikita A Tarkunov
(NA)
Dmitry N Merekin
(DN)
Samandar M Ismoilov
(SM)
Petr P Perovskii
(PP)
Artem A Nikitenko
(AA)
Vladimir A Shmyrev
(VA)
Anna N Shilova
(AN)
Dmitry N Ponomarev
(DN)
Sergey M Efremov
(SM)
Olga L Barbarash
(OL)
Maxim V Larionov
(MV)
Evgeniy D Bazdryev
(ED)
Maria G Calabrò
(MG)
Anna M Scandroglio
(AM)
Giuseppe Dalessandro
(G)
Giuseppe Giardina
(G)
Silvia Ajello
(S)
Giacomo Monti
(G)
Nora Di Tomasso
(N)
Stefano Turi
(S)
Marina Pieri
(M)
Aldo D Milano
(AD)
Tommaso Loizzo
(T)
Lorenzo Giovannico
(L)
Vito Gazzilli
(V)
Francesca Di Serio
(F)
Elisa Mascolo
(E)
Micaela De Palo
(M)
Crescenzia Rotunno
(C)
Adriano De Santis
(A)
Giorgio Kounakis
(G)
Carmine Carbone
(C)
Giuseppe Speziale
(G)
William K K Wu
(WKK)
Lin Zhang
(L)
Gordon Y S Choi
(GYS)
Wai Tat Wong
(WT)
Innes Y P Wan
(IYP)
Randolph H L Wong
(RHL)
Beaker Fung
(B)
Eva Lee
(E)
Ka Yan Hui
(KY)
Yuanyuan Tian
(Y)
Chee S Chan
(CS)
Yingzhi Liu
(Y)
Winnie W S Chan
(WWS)
Mark Pullan
(M)
Mark Field
(M)
Debbie Harrington
(D)
Andrew F Smallwood
(AF)
Victoria G Cottam
(VG)
Elizabeth M Radford
(EM)
Sarah J Milgate
(SJ)
Alain Rolli
(A)
Atul Anand
(A)
Lucy Marshall
(L)
Fiona E Strachan
(FE)
Renzo Pessotto
(R)
Vipin Zamvar
(V)
Mohamad N Bittar
(MN)
Andrew Duncan
(A)
Vasudevan Vasanthi
(V)
Inderpaul Birdi
(I)
Arvind Singh
(A)
Annaliza Sevillano
(A)
WeiFang Xu
(W)
Jin Yu
(J)
Fan Li
(F)
HaiTing Zhan
(H)
Long Yang
(L)
Ligia Camara
(L)
Jaquelline Jardim
(J)
Filomena Galas
(F)
Fabio Jatene
(F)
Luis Dallan
(L)
Graziela Ferreira
(G)
Mariana V Furtado
(MV)
Karen Ruschel
(K)
Clarissa B Pinto
(CB)
Mauren P Haeffner
(MP)
Laís M Hoscheidt
(LM)
Jéssica M Almeida
(JM)
Geicieli Silva
(G)
Isadora Bressaneli
(I)
Raja Amin Mokhtar
(RA)
Shahrul Hashim
(S)
Keng Peng Cheng
(KP)
Ashvin K Nair
(AK)
Nor Ashikin Md Sari
(NA)
Tyng Yan Ng
(TY)
Mohd Fitry Zainal Abidin
(MF)
Suhaini B Kadiman
(SB)
Kogilavaani Sathiam
(K)
Izzatun N Sabran
(IN)
Cecília Martínez-Bru
(C)
Jesús Álvarez-García
(J)
Jordi Miralles
(J)
René Acosta-Isaac
(R)
Ekaterine Popova
(E)
Paul G Bannon
(PG)
Clara K Chow
(CK)
Lisa Turner
(L)
Lorna Beattie
(L)
Jacques Neelankavil
(J)
Jonathan K Ho
(JK)
Barbara Brzeska
(B)
Aleksandra Palasz
(A)
Jan Rogowski
(J)
P J Devereaux
(PJ)
Andre Lamy
(A)
Richard Whitlock
(R)
Shirley Pettit
(S)
Jessica Vincent
(J)
Katheryn Brady
(K)
Rene V Allard
(RV)
J Stephen Billing
(JS)
Flavia K Borges
(FK)
Katheryn Brady
(K)
Matthew T V Chan
(MTV)
Stephen Choi
(S)
Nazari Dvirnik
(N)
Evgeny Fominskiy
(E)
Stephen Fremes
(S)
Ludhmila Hajjar
(L)
Graham S Hillis
(GS)
Sara Hussain
(S)
Suhaini Kadiman
(S)
Peter Kavsak
(P)
James Khan
(J)
Giovanni Landoni
(G)
Vladimir Lomivorotov
(V)
Marialuz Maestre
(M)
Michael H McGillion
(MH)
Matthew McQueen
(M)
Emily Methangkool
(E)
Joseph D Mills
(JD)
Nicholas L Mills
(NL)
Domenico Paparella
(D)
Joel L Parlow
(JL)
Carisi A Polanczyk
(CA)
Jessica Spence
(J)
Gerard Urrútia
(G)
Chew Yin Wang
(CY)
Valerie Harvey
(V)
Arielle Fernandez
(A)
Eric Harbour
(E)
Natalie Mercuri
(N)
Tracy Miranda
(T)
Allison Serra
(A)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2022 Massachusetts Medical Society.