Prognosis of vascular surgery patients using a quantitative assessment of troponin T release: is the crystal ball still clear?
BACKGROUND
Cardiac troponin T (cTnT) assays with increased sensitivity might increase the number of positive tests. Using the area under the curve (AUC) with serial sampling of cTnT an exact quantification of the myocardial damage size can be made. We compared the prognosis of vascular surgery patients with integrated cTnT-AUC values to continuous and standard 12-lead electrocardiography (ECG) changes.


METHODS
513 Patients were monitored. cTnT sampling was performed on postoperative days 1, 3, 7, 30 and/or at discharge or whenever clinically indicated. If cTnT release occurred, daily measurements of cTnT were performed, until baseline was achieved. CTnT-AUC was quantified and divided in tertiles. All-cause mortality and cardiovascular events (cardiac death and myocardial infarction) were noted during follow-up.


RESULTS
81/513 (16%) Patients had cTnT release. After adjustment for gender, cardiac risk factors, and site and type of surgery, those in the highest cTnT-AUC tertile were associated with a significantly worse cardiovascular outcome and long-term mortality (HR 20.2; 95% CI 10.2-40.0 and HR 4.0; 95% CI 2.0-7.8 respectively). Receiver operator analysis showed that the best cut-off value for cTnT-AUC was <0.01 days*ng m for predicting long-term cardiovascular events and all-cause mortality.


CONCLUSIONS
In vascular surgery patients quantitative assessment of cTnT strongly predicts long-term outcome.
Winkel
T A
TA
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Schouten
O
O
Hoeks
S E
SE
Voûte
M T
MT
Chonchol
M
M
Goei
D
D
Flu
W-J
WJ
van Kuijk
J-P
JP
Lindemans
J
J
Verhagen
H J M
HJ
Bax
J J
JJ
Poldermans
D
D
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality
D015415:Biomarkers; C545568:TNNT2 protein, human; D020107:Troponin T