Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery.

Autor: Gualandro DM; Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland. Electronic address: danielle.gualandro@incor.usp.br., Puelacher C; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland., LuratiBuse G; Department of Anaesthesiology, University Hospital Düsseldorf, Germany; Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland., Lampart A; Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland., Strunz C; Heart Institute (InCor), University of Sao Paulo Medical School, Brazil., Cardozo FA; Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil., Yu PC; Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil., Jaffe AS; Department of Cardiology and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA., Barac S; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland., Bock L; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland., Badertscher P; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland., du Fay de Lavallaz J; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland., Marbot S; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland., Sazgary L; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland., Bolliger D; Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland., Rentsch K; Department of Laboratory Medicine, University Hospital Basel, Switzerland., Twerenbold R; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany., Hammerer-Lercher A; Department of Laboratory Medicine, Cantonal Hospital Aarau, Switzerland., Melo ES; Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil., Calderaro D; Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil., Duarte AJ; Laboratory of Immunogenetics and Experimental Transplantation, University of Sao Paulo Medical School, Brazil., de Luccia N; Vascular and Endovascular Surgery Clinic of the Clinics Hospital, University of São Paulo Medical School, Brazil., Caramelli B; Interdisciplinary Medicine in Cardiology Unit, Cardiology Department, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil., Mueller C; Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.
Jazyk: angličtina
Zdroj: American heart journal [Am Heart J] 2018 Sep; Vol. 203, pp. 67-73. Date of Electronic Publication: 2018 Jul 05.
DOI: 10.1016/j.ahj.2018.06.012
Abstrakt: Background: We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery.
Methods: We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery.
Results: Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns).
Conclusions: Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
(Copyright © 2018 Elsevier, Inc. All rights reserved.)
Databáze: MEDLINE
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