The relative merits of using a high-sensitivity cardiac Troponin T assay compared to a nonhigh-sensitivity troponin T assay after noncardiac surgery - 16/08/24
, Daniel I. Sessler, MD d, Maria Tiboni, MD b, Ameen Patel, MD b, Yannick LeManach, MD, PhD a, b, c, Diane Heels-Ansdell, BSc, MSc c, Sadeesh Srinathan, MD e, Chew Yin Wang, MBChB f, Clara Chow, MD, PhD g, h, Emmanuelle Duceppe, MD, PhD a, i, Peter Kavsak, BSc, PhD j, Sandra N. Ofori, MBBS, MSc a, b, Shirley Pettit, RN a, Otavio Berwanger, MD, PhD k, Andrea Kurz, MD l, m, Alparslan Turan, MD l, Ana Claudia Tonelli, MD, PhD n, o, PJ Devereaux, MD, PhD a, b, cOn behalf of
VISION Study Investigators
Résumé |
Introduction |
Troponin elevation after noncardiac surgery is associated with an elevated risk of 30-day mortality. Little is known about relative merit of using a high-sensitivity Troponin T (hsTnT), the fifth-generation assay, vs the nonhigh sensitivity Troponin T (non-hsTnT), the fourth-generation assay, in the noncardiac surgery setting. We aimed to identify whether hsTnT can identify additional patients at risk that would have gone undetected with non-hsTnT measurement.
Methods |
The VISION Study included 40,004 noncardiac surgery patients with postoperative troponin measurements. Among them, 1,806 patients had both fourth-generation non-hsTnT and fifth-generation hsTnT concomitant measurements (4,451 paired results). We compared the absolute concentrations, the timing, and the impact of different thresholds on predicting 30-day major cardiovascular complications (composite of death, nonfatal cardiac arrest, coronary revascularization, and congestive heart failure).
Results |
Based on the manufacturers’ threshold of 14 ng/L, 580 (32.1%) patients had postoperative hsTnT concentrations greater than the threshold, while their non-hsTnT concentrations were below the manufacturer's threshold. These 580 patients had higher risk of major cardiovascular events (OR 2.33; CI 95% 1.04-5.23; P = .049) than patients with hsTnT concentrations below the manufacturer threshold. Among patients with myocardial injury after noncardiac surgery, only 50% would be detected by the fourth-generation non-hsTnT assay at 6 to 12 hours postoperative as compared to 85% with the fifth-generation hsTnT assay (P-value < .001).
Conclusions |
Within the first 3 postoperative days, fifth-generation hsTnT identified at least 1 in 3 patients with troponin elevation that would have gone undetected by fourth-generation non-hsTnT using published thresholds in this setting. Furthermore, fifth-generation hsTnT identified patients with an elevation earlier than fourth-generation non-hsTnT, indicating potential to improve postoperative risk stratification.
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Vol 275
P. 45-52 - septembre 2024 Retour au numéro
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