Association between troponin I levels and mortality among patients undergoing acute high-risk abdominal surgery-A
Charlotte Tiffanie Bendtz Kanstrup1,2, Camilla Mattesen Serup1,3, Kristina Johansen Svarre1,3
1Department of Surgery, Copenhagen University Hospital - North Zealand, Hillerød, Denmark.
Background:
Myocardial injury after noncardiac surgery (MINS) is associated with 30-day mortality in heterogeneous surgical populations but is barely described after acute high-risk abdominal surgery. The impact of dynamic changes has not previously been investigated. The objectives were to determine the incidence of MINS in this population, the association between mortality and MINS, and whether plasma troponin I (TnI) dynamics have any impact on mortality.
Methods:
A prospective cohort study of 341 patients undergoing acute high-risk gastrointestinal surgery was conducted. Plasma TnI was measured at the first four postoperative days. MINS was defined as any increased TnI level >59 ng/L. TnI dynamic required either two succeeding measurements of TnI >59 ng/L with a >20% increase/fall or one measurement of TnI >59 ng/L with a succeeding measurement of TnI <59 ng/L with a >50% decrease. Adjusted mortality rates were calculated using inverse probability of treatment weighting and competing risk analyses.
Results:
The incidence of MINS was 23.8% and dynamic TnI changes occurred in 15.6% of the patients. The unadjusted 30-day and 1-year mortality were 19.8% and 35.9% in patients with MINS, compared with 2.7% and 11.6%, respectively, in patients without MINS (p < 0.001). After adjusting, the differences remained significant. There was no difference in mortality between patients with or without dynamic changes in TnI level.
Conclusion:
MINS occurred frequently and was associated with increased mortality. TnI monitoring might help identify patients with increased risk of mortality and improve care. Research on preventive measures and treatments is warranted.
Trial Registration Number And Agency:
ClinicalTrials.gov Identifier: NCT05933837, retrospective registered.
Insights
Myocardial injury after noncardiac surgery (MINS) is common after high-risk abdominal surgery and significantly increases mortality risk. Dynamic changes in troponin I levels did not impact mortality outcomes in this patient group.
Area of Science:
- Cardiology
- Perioperative Medicine
- Gastrointestinal Surgery
Background:
- Myocardial injury after noncardiac surgery (MINS) is linked to mortality but understudied in acute high-risk abdominal surgery.
- The influence of dynamic changes in cardiac biomarkers post-surgery remains unclear.
Purpose of the Study:
- To determine the incidence of MINS in patients undergoing acute high-risk gastrointestinal surgery.
- To assess the association between MINS and 30-day/1-year mortality.
- To investigate the impact of plasma troponin I (TnI) dynamics on mortality.
Main Methods:
- Prospective cohort study of 341 patients undergoing acute high-risk gastrointestinal surgery.
- Plasma TnI measured daily for four postoperative days; MINS defined as TnI >59 ng/L.
- Dynamic TnI changes defined by specific increase/decrease thresholds; mortality adjusted using inverse probability of treatment weighting and competing risk analyses.
Main Results:
- MINS incidence was 23.8%; dynamic TnI changes occurred in 15.6% of patients.
- MINS significantly associated with higher unadjusted and adjusted 30-day and 1-year mortality (p < 0.001).
- No significant difference in mortality observed between patients with or without dynamic TnI changes.
Conclusions:
- MINS is frequent and a significant predictor of increased mortality following acute high-risk abdominal surgery.
- Plasma TnI monitoring can identify high-risk patients, potentially improving care.
- Further research into preventive strategies and treatments for MINS is necessary.
More Related Videos
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Acute Pancreatitis II: Clinical Manifestations and Management