title: Prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurement after noncardiac surgery: a systematic review and meta-analysis.
abstract: BACKGROUND
  There is uncertainty regarding the prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurements after noncardiac surgery.
  
  
  METHODS
  The current study undertook a systematic review and meta-analysis. The study used six search strategies and included noncardiac surgery studies that provided data from a multivariable analysis assessing whether a postoperative troponin or creatine kinase muscle and brain isoenzyme measurement was an independent predictor of mortality or a major cardiovascular event. Independent investigators determined study eligibility and abstracted data in duplicate.
  
  
  RESULTS
  Fourteen studies, enrolling 3,318 patients and 459 deaths, demonstrated that an increased troponin measurement after surgery was an independent predictor of mortality (odds ratio [OR] 3.4, 95% confidence interval [CI] 2.2-5.2), but there was substantial heterogeneity (I(2) = 56%). The independent prognostic capabilities of an increased troponin value after surgery in the 10 studies that assessed intermediate-term (≤ 12 months) mortality was an OR = 6.7 (95% CI 4.1-10.9, I(2) = 0%) and in the 4 studies that assessed long-term (more than 12 months) mortality was an OR = 1.8 (95% CI 1.4-2.3, I(2) = 0%; P < 0.001 for test of interaction). Four studies, including 1,165 patients and 202 deaths, demonstrated an independent association between an increased creatine kinase muscle and brain isoenzyme measurement after surgery and mortality (OR 2.5, 95% CI 1.5-4.0, I(2) = 4%).
  
  
  CONCLUSIONS
  An increased troponin measurement after surgery is an independent predictor of mortality, particularly within the first year; limited data suggest an increased creatine kinase muscle and brain isoenzyme measurement also predicts subsequent mortality. Monitoring troponin measurements after noncardiac surgery may allow physicians to better risk stratify and manage their patients.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Rajesh
authors.initials: R
authors.lastname: Hiralal
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Villar
authors.forename: Matthew
authors.initials: M
authors.lastname: McQueen
authors.forename: Edward
authors.initials: E
authors.lastname: McFalls
authors.forename: Miodrag
authors.initials: M
authors.lastname: Filipovic
authors.forename: Holger
authors.initials: H
authors.lastname: Schünemann
authors.forename: John
authors.initials: J
authors.lastname: Sear
authors.forename: Pierre
authors.initials: P
authors.lastname: Foex
authors.forename: Wendy
authors.initials: W
authors.lastname: Lim
authors.forename: Giora
authors.initials: G
authors.lastname: Landesberg
authors.forename: Gilles
authors.initials: G
authors.lastname: Godet
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
authors.forename: Francesca
authors.initials: F
authors.lastname: Bursi
authors.forename: Miklos D
authors.initials: MD
authors.lastname: Kertai
authors.forename: Neera
authors.initials: N
authors.lastname: Bhatnagar
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
mesh_terms: D015415:Biomarkers / Q000032:analysis; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality; D052279:Creatine Kinase, MB Form / Q000032:analysis*; D006801:Humans; D011379:Prognosis; D013514:Surgical Procedures, Operative / Q000401:mortality*; D014336:Troponin / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014336:Troponin; D052279:Creatine Kinase, MB Form