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EVALUATION OF PERIOPERATIVE HIGH-SENSITIVE CARDIAC TROPONIN I AS A PREDICTIVE BIOMARKER OF MAJOR ADVERSE
Alejandro Millán-Figueroa1, Juan M López-Navarro1, Iván Pérez-Díaz1,2
1Department of Internal Medicine, Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico City, Mexico.
Insights
Pre-operative high-sensitivity cardiac troponin I (hs-cTnI) levels predict major adverse cardiac events (MACE) and mortality after noncardiac surgery. Elevated hs-cTnI concentrations indicate increased risk for MACE and death within 1 year.
Area of Science:
- Cardiology
- Perioperative Medicine
- Biomarkers
Background:
- Perioperative high-sensitivity troponin levels are linked to major adverse cardiac events (MACE) and mortality.
- Understanding these associations is crucial for risk stratification in noncardiac surgery.
Purpose of the Study:
- To assess the predictive capability of high-sensitivity cardiac troponin I (hs-cTnI) for MACE and all-cause mortality.
- To evaluate these predictions at 30-day and 1-year follow-up periods post-noncardiac surgery.
Main Methods:
- Prospective cohort study including patients aged ≥45 (men) or ≥55 (women) with cardiovascular risk factors undergoing intermediate/high-risk noncardiac surgery.
- hs-cTnI levels measured at baseline (24h pre-surgery) and post-operatively (24h post-surgery).
- Demographic and clinical data collected from patient charts.
Main Results:
- Higher baseline and post-operative hs-cTnI concentrations were observed in patients who experienced MACE.
- Baseline hs-cTnI > 6.2 pg/ml showed a hazard ratio (HR) of 5.70 for 30-day MACE.
- Baseline hs-cTnI > 3.3 pg/ml had an HR of 12.86 for 1-year MACE, and hs-cTnI > 4.5 pg/ml predicted 1-year mortality with an HR of 14.43.
Conclusions:
- Pre-operative hs-cTnI is an independent predictor of MACE at 30 days and 1 year after noncardiac surgery.
- Pre-operative hs-cTnI also predicts all-cause mortality at 1 year post-noncardiac surgery.
Background:
Various studies suggest that perioperative concentrations of high-sensitivity troponins are incremental and predictive factors of a major adverse cardiac event (MACE) and all-cause mortality.
Objective:
The objective of the study was to evaluate the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) in the development of MACE and all-cause mortality, within 30-days and 1-year follow-up after noncardiac surgery.
Methods:
In this prospective cohort study, we included men ≥ 45 years and women ≥ 55 years with ≥ 2 cardiovascular risk factors and undergoing intermediate or high-risk noncardiac surgery. Demographic and clinical information was collected from clinical charts. We measured baseline hs-cTnI 24 h before surgery, and its post-operative concentration 24 h after surgery.
Results:
In the entire sample, 8 patients (8.6%) developed MACE at 30-days follow-up (4 deaths), 12 (12.9%) within the 1st year (7 deaths), and 17 (18.2%) after complete post-surgical follow-up (10 deaths). We observed higher baseline and post-operative concentrations in patients who presented MACE (12 pg/ml vs. 3.5 pg/ml; p = 0.001 and 18.3 pg/ml vs. 5.45 pg/ml; p = 0.009, respectively). The hazard ratios (HRs) calculated by Cox regression analysis between the hs-cTnI baseline concentration and the post-operative development of MACE at 30-days and 1-year were 5.70 (95% confidence interval [CI], 1.10-29.40) with hs-cTnI > 6.2 pg/ml and 12.86 (95% CI, 1.42-116.34) with hs-cTnI > 3.3 pg/ml, respectively. The estimated post-operative HR death risk at 1-year was 14.43 (95% CI, 1.37-151.61) with hs-cTnI > 4.5 pg/ml.
Conclusions:
Pre-operative hs-cTnI was an independent predictive risk factor for MACE at 30-days and 1-year after noncardiac surgery and for all-cause mortality at 1-year after noncardiac surgery.
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