title: Troponin T as a marker for myocardial ischemia in patients undergoing major noncardiac surgery.
abstract: To assess the diagnostic performance of cardiac troponin T as a marker for myocardial injury in patients undergoing major noncardiac surgery, we prospectively collected preoperative and postoperative clinical data, including measurements for creatine kinase (CK), CK-MB, and troponin T for 1,175 patients undergoing major noncardiac surgery. Acute myocardial infarction was diagnosed in 17 patients (1.4%) by a reviewer who was blinded to troponin T data and who used CK-MB and electrocardiographic criteria to define acute myocardial infarction. Other predischarge major cardiac complications were detected for another 17 patients. Troponin T elevations (>0.1 ng/ml) occurred in 87% of patients with and in 16% of patients without myocardial infarction. Among patients without myocardial infarction, troponin T was elevated in 62% of patients with and in 15% of patients without major cardiac complications. Receiver-operating characteristic analysis indicated that troponin T had a performance for the diagnosis of acute myocardial infarction similar to CK-MB, and a significantly better correlation with other major cardiac complications in patients without definitive infarction. Future research should seek to determine the significance of troponin T elevations in patients without complications.
authors.affiliation: Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Lee
authors.forename: E J
authors.initials: EJ
authors.lastname: Thomas
authors.forename: L E
authors.initials: LE
authors.lastname: Ludwig
authors.forename: D B
authors.initials: DB
authors.lastname: Sacks
authors.forename: P A
authors.initials: PA
authors.lastname: Johnson
authors.forename: M C
authors.initials: MC
authors.lastname: Donaldson
authors.forename: E F
authors.initials: EF
authors.lastname: Cook
authors.forename: A
authors.initials: A
authors.lastname: Pedan
authors.forename: K M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: L
authors.initials: L
authors.lastname: Goldman
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D011183:Postoperative Complications / Q000097:blood*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood*; D020107:Troponin T
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase