Clinical use of ultrasensitive cardiac troponin I assay in intermediate- and high-risk surgery patients.
BACKGROUND
Cardiac troponin levels have been reported to add value in the detection of cardiovascular complications in noncardiac surgery. A sensitive cardiac troponin I (cTnI) assay could provide more accurate prognostic information.


METHODS
This study prospectively enrolled 142 patients with at least one Revised Cardiac Risk Index risk factor who underwent noncardiac surgery. cTnI levels were measured postoperatively. Short-term cardiac outcome predictors were evaluated.


RESULTS
cTnI elevation was observed in 47 patients, among whom 14 were diagnosed as having myocardial infarction (MI). After 30 days, 16 patients had major adverse cardiac events (MACE). Excluding patients with a final diagnosis of MI, predictors of cTnI elevation included dialysis, history of heart failure, transoperative major bleeding, and elevated levels of pre- and postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP). Maximal cTnI values showed the highest sensitivity (94%), specificity (75%), and overall accuracy (AUC 0.89; 95% CI 0.80-0.98) for postoperative MACE. Postoperative cTnI peak level (OR 9.4; 95% CI 2.3-39.2) and a preoperative NT-proBNP level ≥917 pg/mL (OR 3.47; 95% CI 1.05-11.6) were independent risk factors for MACE.


CONCLUSIONS
cTnI was shown to be an independent prognostic factor for cardiac outcomes and should be considered as a component of perioperative risk assessment.
Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil.
Flávia Kessler
FK
Borges
Cardiology Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil.
Mariana Vargas
MV
Furtado
Cardiology Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil.
Ana Paula Webber
AP
Rossini
Cardiology Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil.
Carolina
C
Bertoluci
Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil.
Vinícius Leite
VL
Gonzalez
Cardiology Division, School of Medicine, Federal University of Pelotas, Gomes Carneiro 1, 96010-610 Pelotas, RS, Brazil.
Eduardo Gehling
EG
Bertoldi
Department of Internal Medicine, School of Medicine, Federal University of Rio Grande do Sul, Ramiro Barcelos 2400, 90035-003 Porto Alegre, RS, Brazil.
Luíza Guazzeli
LG
Pezzali
Cardiology Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil.
Daniel Luft
DL
Machado
Department of Internal Medicine, School of Medicine, Federal University of Rio Grande do Sul, Ramiro Barcelos 2400, 90035-003 Porto Alegre, RS, Brazil.
Denis Maltz
DM
Grutcki
Department of Internal Medicine, School of Medicine, Federal University of Rio Grande do Sul, Ramiro Barcelos 2400, 90035-003 Porto Alegre, RS, Brazil.
Leandro Gazziero
LG
Rech
Department of Internal Medicine, School of Medicine, Federal University of Rio Grande do Sul, Ramiro Barcelos 2400, 90035-003 Porto Alegre, RS, Brazil.
Mariana
M
Magalhães
Cardiology Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil ; Department of Internal Medicine, School of Medicine, Federal University of Rio Grande do Sul, Ramiro Barcelos 2400, 90035-003 Porto Alegre, RS, Brazil ; Institute for Health Technology Assessment (IATS), Hospital de Clínicas de Porto Alegre, Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil.
Carisi Anne
CA
Polanczyk
D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism* / Q000401:mortality / Q000601:surgery; D009206:Myocardium / Q000378:metabolism*; D018579:Patient Selection; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000378:metabolism*
D015415:Biomarkers; D019210:Troponin I