RT Journal Article
T1 Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery
A1 Devereaux P. J., 
A1 Biccard, Bruce M.
A1 Sigamani, Alben
A1 Xavier, Denis
A1 Chan, Matthew T. V.
A1 Srinathan, Sadeesh K.
A1 Walsh, Michael
A1 Abraham, Valsa
A1 Pearse, Rupert
A1 Wang, C. Y.
A1 Sessler, Daniel I.
A1 Kurz, Andrea
A1 Szczeklik, Wojciech
A1 Berwanger, Otavio
A1 Villar, Juan Carlos
A1 Malaga, German
A1 Garg, Amit X.
A1 Chow, Clara K.
A1 Ackland, Gareth
A1 Patel, Ameen
A1 Kessler Borges, Flavia
A1 Belley Cote, Emilie P.
A1 Duceppe, Emmanuelle
A1 Spence, Jessica
A1 Tandon, Vikas
A1 Williams, Colin
A1 Sapsford, Robert J.
A1 Polanczyk, Carisi A.
A1 Tiboni, Maria
A1 Alonso Coello, Pablo
A1 Faruqui, Atiya
A1 Heels Ansdell, Diane
A1 Lamy, Andre
A1 Whitlock, Richard
A1 LeManach, Yannick
A1 Roshanov, Pavel S.
A1 McGillion, Michael
A1 Kavsak, Peter
A1 McQueen, Matthew J.
A1 Thabane, Lehana
A1 Rodseth, Reitze N.
A1 Lurati Buse, Giovanna A.
A1 Bhandari, Mohit
A1 Garutti Martínez, Ignacio
A1 Jacka, Michael J.
A1 Schünemann, Holger J.
A1 Cortes, Olga Lucía
A1 Coriat, Pierre
A1 Dvirnik, Nazari
A1 Botto, Fernando
A1 Pettit, Shirley
A1 Jaffe, Allan S.
A1 Guyatt, Gordon H.
AB Importance: Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS).Objective: To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality).Design, setting, and participants: Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013.Exposures: Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement.Main outcomes and measures: A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-day mortality of 3% or higher. To determine potential diagnostic criteria for MINS, regression analyses ascertained if postoperative hsTnT elevations required an ischemic feature (eg, ischemic symptom or electrocardiography finding) to be associated with 30-day mortality.Results: Among 21 842 participants, the mean age was 63.1 (SD, 10.7) years and 49.1% were female. Death within 30 days after surgery occurred in 266 patients (1.2%; 95% CI, 1.1%-1.4%). Multivariable analysis demonstrated that compared with the reference group (peak hsTnT <5 ng/L), peak postoperative hsTnT levels of 20 to less than 65 ng/L, 65 to less than 1000 ng/L, and 1000 ng/L or higher had 30-day mortality rates of 3.0% (123/4049; 95% CI, 2.6%-3.6%), 9.1% (102/1118; 95% CI, 7.6%-11.0%), and 29.6% (16/54; 95% CI, 19.1%-42.8%), with corresponding adjusted HRs of 23.63 (95% CI, 10.32-54.09), 70.34 (95% CI, 30.60-161.71), and 227.01 (95% CI, 87.35-589.92), respectively. An absolute hsTnT change of 5 ng/L or higher was associated with an increased risk of 30-day mortality (adjusted HR, 4.69; 95% CI, 3.52-6.25). An elevated postoperative hsTnT (ie, 20 to <65 ng/L with an absolute change ≥5 ng/L or hsTnT ≥65 ng/L) without an ischemic feature was associated with 30-day mortality (adjusted HR, 3.20; 95% CI, 2.37-4.32). Among the 3904 patients (17.9%; 95% CI, 17.4%-18.4%) with MINS, 3633 (93.1%; 95% CI, 92.2%-93.8%) did not experience an ischemic symptom.Conclusions and relevance: Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.
PB American Medical Association
SN 0098-7484
YR 2017
FD 2017-04-01
LK https://hdl.handle.net/20.500.14352/97973
UL https://hdl.handle.net/20.500.14352/97973
LA eng
NO Writing Committee for the VISION Study Investigators; Devereaux PJ, Biccard BM, Sigamani A, Xavier D, Chan MTV, Srinathan SK, Walsh M, Abraham V, Pearse R, Wang CY, Sessler DI, Kurz A, Szczeklik W, Berwanger O, Villar JC, Malaga G, Garg AX, Chow CK, Ackland G, Patel A, Borges FK, Belley-Cote EP, Duceppe E, Spence J, Tandon V, Williams C, Sapsford RJ, Polanczyk CA, Tiboni M, Alonso-Coello P, Faruqui A, Heels-Ansdell D, Lamy A, Whitlock R, LeManach Y, Roshanov PS, McGillion M, Kavsak P, McQueen MJ, Thabane L, Rodseth RN, Buse GAL, Bhandari M, Garutti I, Jacka MJ, Schünemann HJ, Cortes OL, Coriat P, Dvirnik N, Botto F, Pettit S, Jaffe AS, Guyatt GH. Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA. 2017 Apr 25;317(16):1642-1651. doi: 10.1001/jama.2017.4360. PMID: 28444280.
NO INSTITUTO SALUD CARLOS III
NO Fundacio La Marató
DS Docta Complutense
RD 10 abr 2025