TY - JOUR
T1 - Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery
AU - TropoVasc and BASEL-PMI Investigators
AU - Gualandro, Danielle M.
AU - Puelacher, Christian
AU - LuratiBuse, Giovanna
AU - Lampart, Andreas
AU - Strunz, Celia
AU - Cardozo, Francisco A.
AU - Yu, Pai C.
AU - Jaffe, Allan S.
AU - Barac, Sanela
AU - Bock, Lukas
AU - Badertscher, Patrick
AU - du Fay de Lavallaz, Jeanne
AU - Marbot, Stella
AU - Sazgary, Lorraine
AU - Bolliger, Daniel
AU - Rentsch, Katharina
AU - Twerenbold, Raphael
AU - Hammerer-Lercher, Angelika
AU - Melo, Edielle S.
AU - Calderaro, Daniela
AU - Duarte, Alberto JS
AU - de Luccia, Nelson
AU - Caramelli, Bruno
AU - Mueller, Christian
N1 - Publisher Copyright:
© 2018 Elsevier, Inc.
PY - 2018/9
Y1 - 2018/9
N2 - Background: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. Methods: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. Results: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P <.001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P <.001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0–2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59–0.75) for hs-cTnI versus 0.59 (95% CI 0.51–0.67, P =.012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3–2.0, and aOR 3.0, 95% CI 2.0–4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71–0.83, and 0.79, 95% CI 0.73–0.85, P = ns). Conclusions: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
AB - Background: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery. Methods: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery. Results: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P <.001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P <.001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0–2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59–0.75) for hs-cTnI versus 0.59 (95% CI 0.51–0.67, P =.012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3–2.0, and aOR 3.0, 95% CI 2.0–4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71–0.83, and 0.79, 95% CI 0.73–0.85, P = ns). Conclusions: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
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U2 - 10.1016/j.ahj.2018.06.012
DO - 10.1016/j.ahj.2018.06.012
M3 - Article
C2 - 30041065
AN - SCOPUS:85050110604
SN - 0002-8703
VL - 203
SP - 67
EP - 73
JO - American heart journal
JF - American heart journal
ER -