title: Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery.
abstract: OBJECTIVE
  We aimed to evaluate the incremental value of high-sensitive troponin T (hsTnT) for risk prediction prior to non-cardiac surgery in comparison with the established revised cardiac index.
  
  
  RESULTS
  In this prospective, international multicentre observational study, 979 patients prior to non-cardiac surgery were enrolled. The endpoints were in-hospital mortality, the combination of death, acute myocardial infarction, cardiac arrest, cardio-pulmonary resuscitation, and acute decompensated heart failure. Twenty-five patients (2.6%) deceased and 36 (3.7%) of the patients experienced the combined endpoint. Cardiac markers were elevated in those patients who died when compared with survivors (hsTnT: 21 ng/L vs. 7 ng/L; P < 0.001; NT-proBNP: 576 pg/mL vs. 166 pg/mL; P < 0.001). Applying a cut-off for hsTnT of 14 ng/L and for NT-proBNP of 300 pg/mL, those patients with elevated hsTnT had a mortality of 6.9 vs. 1.2% (P < 0.001) and with elevated NT-proBNP 4.8 vs. 1.4% (P = 0.002). The highest AUC of the ROC curve was found for hsTnT as a predictor for mortality of 0.809. In a multivariate Cox regression analyses, hsTnT was the strongest independent predictor for the combined endpoint [HR 2.6 (95% CI: 1.3-5.3); P = 0.01].
  
  
  CONCLUSIONS
  High-sensitive troponin T provides strong prognostic information in patients undergoing non-cardiac surgery incremental to the widely accepted revised cardiac index.
authors.affiliation: Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. m.weber@kreiskliniken-dadi.de
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Andreas
authors.initials: A
authors.lastname: Luchner
authors.forename: Manfred
authors.initials: M
authors.lastname: Seeberger
authors.forename: Seeberger
authors.initials: S
authors.lastname: Manfred
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.forename: Axel
authors.initials: A
authors.lastname: Schlitt
authors.forename: Svetlana
authors.initials: S
authors.lastname: Apostolovic
authors.forename: Radmilo
authors.initials: R
authors.lastname: Jankovic
authors.forename: Dragic
authors.initials: D
authors.lastname: Bankovic
authors.forename: Marina
authors.initials: M
authors.lastname: Jovic
authors.forename: Veselin
authors.initials: V
authors.lastname: Mitrovic
authors.forename: Holger
authors.initials: H
authors.lastname: Nef
authors.forename: Helge
authors.initials: H
authors.lastname: Mollmann
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006333:Heart Failure / Q000209:etiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008163:Luminescent Measurements / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D020107:Troponin T / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain