Are Post-Op hsTnT and 30-day Mortality Linked in Noncardiac Sx?

HealthDay News — Peak postoperative high-sensitivity troponin T (hsTnT) is associated with increased risk of 30-day mortality among patients undergoing noncardiac surgery, according to a study published in the Journal of the American Medical Association.

PJ Devereaux, MD, PhD, from McMaster University in Ontario, Canada, and colleagues conducted a prospective cohort study involving 21,842 participants who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement.

The researchers found that 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 were associated with 30-day mortality rates of 3%, 9.1%, and 29.6%, respectively, compared with the reference group (peak hsTnT <5ng/L), with corresponding adjusted hazard ratios of 23.63, 70.34, and 227.01, respectively. Increased risk of 30-day mortality was seen with an absolute hsTnT change of 5 ng/L or higher (adjusted hazard ratio, 4.69). There was a correlation for elevated postoperative hsTnT (20 to <65 ng/L with an absolute change of ≥5 ng/L or hsTnT ≥65 ng/L) without an ischemic feature with 30-day mortality (adjusted hazard ratio, 3.2). Overall, 93.1% of the 3904 patients with myocardial injury after noncardiac surgery did not experience an ischemic symptom.

“Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first three days after surgery was significantly associated with 30-day mortality,” the researchers write.

Several researchers disclosed financial ties to the pharmaceutical and medical device industries.

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Writing Committee for the VISION Study Investigators, Devereaux PJ, Biccard BM, Sigamani A, et al. Association of postoperative high sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardic surgery. JAMA. 2017 Apr 25;317(16):1642-1651. doi: 10.1001/jama.2017.4360.