Kinetics of troponin I in patients with myocardial injury after noncardiac surgery
-
Judith A.R. van Waes
,
Linda M. Peelen
Abstract
Background:
Myocardial injury after noncardiac surgery, as measured by troponin elevation, is strongly associated with mortality. However, it is unknown in which patients prognosis can be improved. The presence of kinetic changes of troponin may be associated with a worse prognosis and warrant more aggressive management. Therefore, we aimed to study the kinetics of troponin in patients with postoperative myocardial injury, and to determine the added predictive value of kinetic changes of troponin on mortality.
Methods:
This cohort study included patients with myocardial injury after noncardiac surgery. Troponin I (TnI) was measured on the first three postoperative days. The primary outcome was all-cause 1-year mortality. We studied both absolute and relative TnI changes, and determined the delta TnI that was associated with mortality to distinguish a rise-and-fall TnI pattern from a stable TnI pattern. Next, we determined the added predictive value of a rise-and-fall TnI pattern for mortality.
Results:
In total, 634 patients were included. The risk ratio (RR) for mortality increased significantly with an absolute delta TnI of ≥200 ng/L (RR 1.5, 99.4% CI 1.0–2.2, p=0.003). Using this delta TnI to define a rise-and-fall pattern, 459 patients (72%) had a stable TnI pattern and 175 patients (28%) had a rise-and-fall pattern. When added to a model including the highest TnI value and variables from the revised cardiac risk index (RCRI), the TnI pattern did not increase the predictive value for mortality.
Conclusions:
A postoperative TnI rise-and-fall pattern was associated with 1-year mortality, but had no added value in addition to the highest TnI level to predict 1-year mortality. Therefore, postoperative TnI kinetics are not useful for further mortality risk stratification in patients with myocardial injury after noncardiac surgery.
Acknowledgments
We acknowledge Wietze Pasma and the trial office nurses under the direction of Sandra Numan for their contributions in data collection.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: This study was funded by a grant from the International Anesthesia Research Society (Clinical Scholar Research Award 2011 to dr. Van Klei), by a grant from the Friends of the University Medical Center Utrecht foundation/the Dirkzwager-Assink Fund to dr. Van Klei and by departmental sources.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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©2017 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
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- Infectious Diseases
- P35 and P22 Toxoplasma gondii antigens abbreviate regions to diagnose acquired toxoplasmosis during pregnancy: toward single-sample assays
- Letters to the Editor
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Artikel in diesem Heft
- Frontmatter
- Editorial
- The central role of external quality assurance in harmonisation and standardisation for laboratory medicine
- Review
- Fecal calprotectin in inflammatory bowel diseases: update and perspectives
- Mini Review
- Factor VIIa-antithrombin complex: a possible new biomarker for activated coagulation
- Opinion Papers
- Improving quality in the preanalytical phase through innovation, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE)
- Metabolite profiling can change health-care delivery to obese patients with fatty liver disease: the search for biomarkers
- Genetics and Molecular Diagnostics
- Rapid screening for targeted genetic variants via high-resolution melting curve analysis
- Evaluation of the new cobas® HCV genotyping test based on real-time PCRs of three different HCV genome regions
- General Clinical Chemistry and Laboratory Medicine
- Harmonisation of serum dihydrotestosterone analysis: establishment of an external quality assurance program
- Spanish Preanalytical Quality Monitoring Program (SEQC), an overview of 12 years’ experience
- Peer groups splitting in Croatian EQA scheme: a trade-off between homogeneity and sample size number
- Prevalence of pseudonatremia in a clinical laboratory – role of the water content
- Retrospective validation of a β-trace protein interpretation algorithm for the diagnosis of cerebrospinal fluid leakage
- Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a Chinese hospital system perspective
- Performance evaluation of ImmunoCAP® ISAC 112: a multi-site study
- Clinical autoantibody detection by microarray
- Cardiovascular Diseases
- Kinetics of troponin I in patients with myocardial injury after noncardiac surgery
- Infectious Diseases
- P35 and P22 Toxoplasma gondii antigens abbreviate regions to diagnose acquired toxoplasmosis during pregnancy: toward single-sample assays
- Letters to the Editor
- Deciphering a macro-troponin I complex; a case report
- Interference of laboratory disinfection with trichloro-isocyanuric acid on cardiac troponin I measurement using the Vitros immunoassay system
- Massive interference in free T4 and free T3 assays misleading clinical judgment
- In defense of aldosterone measurement by immunoassay: a broader perspective
- The prevalence of hemolysis – a survey using hemolysis index
- Detection of BRAFV600K mutant tumor-derived DNA in the pleural effusion from a patient with metastatic melanoma
- Evaluation of the accuracy of the Greiner Bio-One FC Mix Glucose tube
- Congress Abstracts
- 4th EFLM-BD European Conference on Preanalytical Phase Amsterdam (NL), 24–25 March 2017
