title: High-sensitivity cardiac troponin T in prediction and diagnosis of myocardial infarction and long-term mortality after noncardiac surgery.
abstract: BACKGROUND
  Perioperative myocardial infarction (MI) is a serious complication after noncardiac surgery. We hypothesized that preoperative cardiac troponin T detected with a novel high-sensitivity (hs-cTnT) assay will identify patients at risk for acute MI and long-term mortality after major noncardiac surgery.
  
  
  METHODS
  This was a prospective cohort study within the VINO trial (n = 608). Patients had been diagnosed with or had multiple risk factors for coronary artery disease and underwent major noncardiac surgery. Cardiac troponin I (contemporary assay) and troponin T (high-sensitivity assay) and 12-lead electrocardiograms were obtained before and immediately after surgery and on postoperative days 1, 2, and 3.
  
  
  RESULTS
  At baseline before surgery, 599 patients (98.5%) had a detectable hs-cTnT concentration, and 247 (41%) were >14 ng/L (99th percentile). After surgery, 497 patients (82%) had a rise in hs-cTnT (median change in hs-cTnT +2.7 ng/L [interquartile range 0.7-6.8]). During the first 3 postoperative days, there were 9 patients (2.5%) with a preoperative hs-cTnT <14 ng/L with acute MI, compared with 21 patients (8.6%) with a preoperative hs-cTnT >14 ng/L (odds ratio 3.67, 95% CI 1.65-8.15). During long-term follow-up, 80 deaths occurred. The 3-year mortality rate was 11% in patients with a preoperative hs-cTnT concentration <14 ng/L compared with 25% in patients with a preoperative hs-cTnT >14 ng/L (adjusted hazard ratio 2.17, 95% CI 1.19-3.96).
  
  
  CONCLUSIONS
  In this cohort of high-risk patients, preoperative hs-cTnT concentrations were significantly associated with postoperative MI and long-term mortality after noncardiac surgery.
authors.affiliation: Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA. nagelep@wustl.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Nagele
authors.forename: Frank
authors.initials: F
authors.lastname: Brown
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gage
authors.forename: David W
authors.initials: DW
authors.lastname: Gibson
authors.forename: J Philip
authors.initials: JP
authors.lastname: Miller
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe
authors.forename: Fred S
authors.initials: FS
authors.lastname: Apple
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Scott
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D009609:Nitrous Oxide / Q000009:adverse effects; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood*; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D019210:Troponin I; D020107:Troponin T; D014803:Vitamin B Complex; D009609:Nitrous Oxide
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