1. Prediction of perioperative myocardial infarction/injury in high-risk patients after noncardiac surgery.
- Author
-
Meister R, Puelacher C, Glarner N, Gualandro DM, Andersson HA, Pargger M, Huré G, Virant G, Bolliger D, Lampart A, Steiner L, Hidvegi R, Lurati Buse G, Kindler C, Gürke L, Mujagic E, Schaeren S, Clauss M, Lardinois D, Hammerer-Lercher A, Chew M, and Mueller C
- Subjects
- Humans, Aged, ROC Curve, Troponin T, Biomarkers, Myocardial Infarction diagnosis, Myocardial Infarction epidemiology, Myocardial Infarction etiology, Heart Diseases
- Abstract
Aims: Perioperative myocardial infarction/injury (PMI) is a surprisingly common yet difficult-to-predict cardiac complication in patients undergoing noncardiac surgery. We aimed to assess the incremental value of preoperative cardiac troponin (cTn) concentration in the prediction of PMI., Methods and Results: Among prospectively recruited patients at high cardiovascular risk (age ≥65 years or ≥45 years with preexisting cardiovascular disease), PMI was defined as an absolute increase in high-sensitivity cTnT (hs-cTnT) concentration of ≥14 ng/L (the 99th percentile) above the preoperative concentration. Perioperative myocardial infarction/injury was centrally adjudicated by two independent cardiologists using serial measurements of hs-cTnT. Using logistic regression, three models were derived: Model 1 including patient- and procedure-related information, Model 2 adding routinely available laboratory values, and Model 3 further adding preoperative hs-cTnT concentration. Models were also compared vs. preoperative hs-cTnT alone. The findings were validated in two independent cohorts. Among 6944 patients, PMI occurred in 1058 patients (15.2%). The predictive accuracy as quantified by the area under the receiver operating characteristic curve was 0.73 [95% confidence interval (CI) 0.71-0.74] for Model 1, 0.75 (95% CI 0.74-0.77) for Model 2, 0.79 (95% CI 0.77-0.80) for Model 3, and 0.74 for hs-cTnT alone. Model 3 included 10 preoperative variables: age, body mass index, known coronary artery disease, metabolic equivalent >4, risk of surgery, emergency surgery, planned duration of surgery, haemoglobin, platelet count, and hs-cTnT. These findings were confirmed in both independent validation cohorts (n = 722 and n = 966)., Conclusion: Preoperative cTn adds incremental value above patient- and procedure-related variables as well as routine laboratory variables in the prediction of PMI., Competing Interests: Conflict of interest: C.P. reports research grants from Roche Diagnostics, the Swiss Heart Foundation, and the University Hospital Basel during the conduct of this study. D.M.G. reports grants from the Swiss Heart Foundation, grants from the Fundacao de Apoio a Pesquisa do estado de Sao Paulo, Brasil (FAPESP), and personal fees from Roche, outside the submitted work. G.L.B. reports grants from the University of Basel and nonfinancial support from Roche Diagnostics, during the conduct of the study. C.K. reports grants from Forschungsfond Kantonsspital Aarau, during the conduct of the study. A.H.-L. reports research support as well as speaker honoraria from Siemens Healthineers, Abbott Diagnostics, and Beckman Coulter. M.C. reports grants from the Swedish Research Council, ALF-grants, Linköping University. C.M. reports grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the University of Basel, and the University Hospital Basel for this study, as well as grants, personal fees, and nonfinancial support from several diagnostic companies, outside the submitted work. All other authors declare that they have no conflict of interest with this study., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
- Published
- 2023
- Full Text
- View/download PDF