title: Troponin elevations after non-cardiac, non-vascular surgery are predictive of major adverse cardiac events and mortality: a systematic review and meta-analysis.
abstract: BACKGROUND
  Patients undergoing non-cardiac, non-vascular surgery are at risk of major cardiovascular complications. In non-cardiac surgery, troponin elevation has previously been shown to be an independent predictor of major adverse cardiac events and postoperative mortality; however, a majority of studies have focused on vascular surgery patients. The aim of this meta-analysis was to determine whether troponin elevation is a predictor of major adverse cardiac events and mortality within 30 days and 1 yr after non-cardiac, non-vascular surgery.
  
  
  METHODS
  A systematic review and meta-analysis was conducted in January 2016 according to the Meta-analysis Of Observational Studies in Epidemiology guidelines. Both interventional and observational studies measuring troponin within the first 4 days after surgery were eligible. A systematic search was performed in PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials.
  
  
  RESULTS
  Eleven eligible clinical studies (n=2193) were identified. A postoperative troponin elevation was a predictor of 30 day mortality, odds ratio (OR) 3.52 [95% confidence interval (CI) 2.21-5.62; I2=0%], and an independent predictor of 1 yr mortality, adjusted OR 2.53 (95% CI 1.20-5.36; I2=26%). A postoperative troponin elevation was associated with major adverse cardiac events at 30 days, OR 5.92 (95% CI 1.67-20.96; I2=86%), and 1 yr after surgery, adjusted OR 3.00 (95% CI 1.43-6.29; I2=21%).
  
  
  CONCLUSIONS
  Postoperative myocardial injury is an independent predictor of major adverse cardiac events and mortality within 30 days and 1 yr after non-cardiac, non-vascular surgery. The meta-analysis provides evidence that supports troponin monitoring as a cardiovascular risk stratification tool.
authors: Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege and Roskilde, Denmark savb@regionsjaelland.dk.
authors: S
authors: S
authors: Ekeloef
authors: Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege and Roskilde, Denmark.
authors: M
authors: M
authors: Alamili
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: P J
authors: PJ
authors: Devereaux
authors: Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege and Roskilde, Denmark.
authors: I
authors: I
authors: Gögenur
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I
keywords: cardiovascular diseases; mortality; myocardial ischaemia; perioperative period; postoperative complications; troponin