Troponin T level and mortality risk after noncardiac surgery: practical implications of the VISION study.

This review article presents the current state of knowledge about major perioperative cardiovascular complications in noncardiac surgery patients and the role of the currently available stratification models and biomarkers in risk prediction. The authors discuss a recent paper presented by the VISION Investigators in the June edition of the Journal of the American Medical Association and its practical implications in day-to-day perioperative practice. According to this study, the authors conclude that troponin (Tn) measurement up to 3 days after noncardiac surgery substantially improves perioperative risk estimation, and peak Tn values (even the levels previously considered as normal) strongly predict 30-day mortality. One in 25 patients with a peak fourth generation troponin T (TnT) measurement of 0.02 μg/l, 1 in 11 patients with a peak TnT measurement of 0.03 to 0.29 μg/l, and 1 in 6 patients with a peak TnT measurement of 0.30 μg/l or higher will die within 30 days of surgery. Postoperative monitoring of TnT measurements substantially improves risk stratification after noncardiac surgery and may help identify patients requiring further therapeutic interventions.