Incidence and outcomes of perioperative myocardial infarction/injury diagnosed by high-sensitivity cardiac troponin I Academic Article uri icon

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abstract

  • Abstract Background  Perioperative myocardial infarction/injury (PMI) diagnosed by high-sensitivity troponin (hs-cTn) T is frequent and a prognostically important complication of non-cardiac surgery. We aimed to evaluate the incidence and outcome of PMI diagnosed using hs-cTnI, and compare it to PMI diagnosed using hs-cTnT. Methods We prospectively included 2455 patients at high cardiovascular risk undergoing 3111 non-cardiac surgeries, for whom hs-cTnI and hs-cTnT concentrations were measured before surgery and on postoperative days 1 and 2. PMI was defined as a composite of perioperative myocardial infarction (PMIInfarct) and perioperative myocardial injury (PMIInjury), according to the Fourth Universal Definition of Myocardial Infarction. All-cause mortality was the primary endpoint. Results Using hs-cTnI, the incidence of overall PMI was 9% (95% confidence interval [CI] 8–10%), including PMIInfarct 2.6% (95% CI 2.0–3.2) and PMIInjury 6.1% (95% CI 5.3–6.9%), which was lower versus using hs-cTnT: overall PMI 15% (95% CI 14–16%), PMIInfarct 3.7% (95% CI 3.0–4.4) and PMIInjury 11.3% (95% CI 10.2–12.4%). All-cause mortality occurred in 52 (2%) patients within 30 days and 217 (9%) within 1 year. Using hs-cTnI, both PMIInfarct and PMIInjury were independent predictors of 30-day all-cause mortality (adjusted hazard ratio [aHR] 2.5 [95% CI 1.1–6.0], and aHR 2.8 [95% CI 1.4–5.5], respectively) and, 1-year all-cause mortality (aHR 2.0 [95% CI 1.2–3.3], and aHR 1.8 [95% CI 1.2–2.7], respectively). Overall, the prognostic impact of PMI diagnosed by hs-cTnI was comparable to the prognostic impact of PMI using hs-cTnT. Conclusions Using hs-cTnI, PMI is less common versus using hs-cTnT. Using hs-cTnI, both PMIInfarct and PMIInjury remain independent predictors of 30-day and 1-year mortality. Graphic abstract

authors

  • Gualandro, Danielle M
  • Puelacher, Christian
  • Lurati Buse, Giovanna
  • Glarner, Noemi
  • Cardozo, Francisco A
  • Vogt, Ronja
  • Hidvegi, Reka
  • Strunz, Celia
  • Bolliger, Daniel
  • Gueckel, Johanna
  • Yu, Pai C
  • Liffert, Marcel
  • Arslani, Ketina
  • Prepoudis, Alexandra
  • Calderaro, Daniela
  • Hammerer-Lercher, Angelika
  • Lampart, Andreas
  • Steiner, Luzius A
  • Schären, Stefan
  • Kindler, Christoph
  • Guerke, Lorenz
  • Osswald, Stefan
  • Devereaux, Philip
  • Caramelli, Bruno
  • Mueller, Christian
  • Marbot, Stella
  • Strebel, Ivo
  • Genini, Alessandro
  • Rentsch, Katharina
  • Boeddinghaus, Jasper
  • Nestelberger, Thomas
  • Wild, Karin
  • Zimmermann, Tobias
  • Duarte, Alberto JS
  • Buser, Andreas
  • de Luccia, Nelson
  • Koechlin, Luca
  • Wussler, Desiree
  • Walter, Joan
  • Widmer, Velina
  • Freese, Michael
  • Lopez-Ayala, Pedro
  • Twerenbold, Raphael
  • Badertscher, Patrick
  • Seeberger, Esther
  • Wolff, Thomas
  • Mujagic, Edin
  • Mehrkens, Arne
  • Dinort, Julia
  • Fahrni, Gregor
  • Jeger, Raban
  • Kaiser, Christoph
  • Matheus, Mariana
  • Pastana, Adriana F

publication date

  • September 2021