Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Borges, FK; Sessler, DI; Tiboni, M; Patel, A; LeManach, Y; Heels-Ansdell, D; Srinathan, S; Wang, CY; Chow, C; Duceppe, E; Kavsak, P; Ofori, SN; Pettit, S; Berwanger, O; Kurz, A; Turan, A; Tonelli, AC; Devereaux, PJ, , VISION, Study, Investigators.
The relative merits of using a high-sensitivity cardiac Troponin T assay compared to a non-high-sensitivity Troponin T assay after noncardiac surgery.
Am Heart J. 2024;
Doi: 10.1016/j.ahj.2024.05.020
Web of Science
PubMed
FullText
FullText_MUG
- Co-Autor*innen der Med Uni Graz
- Kurz Andrea
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- Abstract:
- INTRODUCTION: Troponin elevation after noncardiac surgery is associated with an elevated risk of 30-day mortality. Little is known about relative merit of using a high-sensitivity Troponin T (hsTnT), the 5th-generation assay, versus the non-high sensitivity Troponin T (non-hsTnT), the 4th-generation assay, in the noncardiac surgery setting. We aimed to identify whether hsTnT can identify additional patients at risk that would have gone undetected with non-hsTnT measurement. METHODS: The VISION Study included 40,004 noncardiac surgery patients with postoperative troponin measurements. Among them, 1806 patients had both 4th-generation non-hsTnT and 5th-generation hsTnT concomitant measurements (4451 paired results). We compared the absolute concentrations, the timing, and the impact of different thresholds on predicting 30-day major cardiovascular complications (composite of death, nonfatal cardiac arrest, coronary revascularization, and congestive heart failure). RESULTS: Based on the manufacturers' threshold of 14 ng/L, 580 (32.1%) patients had postoperative hsTnT concentrations greater than the threshold, while their non-hsTnT concentrations were below the manufacturer's threshold. These 580 patients had higher risk of major cardiovascular events (OR 2.33; CI 95% 1.04-5.23; p=0.049) than patients with hsTnT concentrations below the manufacturer threshold. Among patients with myocardial injury after noncardiac surgery, only 54% would be detected by the 4th-generation non-hsTnT assay at 6-12 hours postoperative as compared to 86% with the 5th-generation hsTnT assay (P value <0.001). CONCLUSIONS: Within the first 3 postoperative days, 5th-generation hsTnT identified at least 1 in 3 patients with troponin elevation that would have gone undetected by 4th-generation non-hsTnT using published thresholds in this setting. Furthermore, 5th-generation hsTnT identified patients with an elevation earlier than 4th-generation non-hsTnT, indicating potential to improve postoperative risk stratification.