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 - Funding Information:
DM Gualandro has received research grants from FAPESP (Sao Paulo Research Foundation) for the submitted work, and speaker or consulting honoraria from Servier, Sanofi, EMS and Roche, outside the submitted work. C Puelacher has received research grants from PPHS (PhD Educational Platform Health Sciences) Basel, outside the submitted work. D Calderaro has received research grants from FAPESP and speaker or consulting honoraria from Bayer, outside the submitted work. Dr. Twerenbold received research support from the Swiss National Science Foundation (P300PB-167,803/1) and speaker honoraria/consulting honoraria from Roche, Abbott, Siemens and Brahms, outside the submitted work. A Hammerer-Lercher has received speaker honoraria from Abbott, outside the submitted work. Professor Caramelli has received research grants from FAPESP, CNPq (National Counsel of Technological and Scientific Development, Brasil), as well as speaker or consulting honoraria from Bayer, Boehringer Ingelheim, Servier, and AbbVie, outside the submitted work. Dr. Jaffe has previously or presently consults for most of the major diagnostic companies, outside the submitted work. Professor Mueller has received research grants Swiss Heart Foundation, grants from Astra Zeneca, grants and non-financial support from University of Basel, and Abbott, during the conduct of the study, and from the European Union, 8sense, Abbott, ALERE, Beckman Coulter, Biomerieux, Brahms, Critical Diagnostics, Nanosphere, Roche, Siemens, Singulex, Sphingotec and the University Hospital Basel, as well as speaker or consulting honoraria from Abbott, ALERE, Astra Zeneca, Biomerieux, BMS, Boehringer Ingelheim, Brahms, Cardiorentis, Novartis, Roche, Sanofi-Aventis, Siemens and Singulex, outside the submitted work.
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 -