High-sensitivity Troponin I Predicts Major Cardiovascular Events after Non-Cardiac Surgery: A Vascular Events in Non-Cardiac Surgery Patients Cohort Evaluation (VISION) Substudy

Flavia K Borges; Emmanuelle Duceppe; Diane Heels-Ansdell; Ameen Patel; Daniel I Sessler; Vikas Tandon; Matthew Chan; Rupert Pearse; Sadeesh Srinathan; Amit X Garg; Robert J Sapsford; Sandra N Ofori; Maura Marcucci; Peter A Kavsak; Shirley Pettit; Jessica Spence; Emilie Belley-Cote; Michael McGillion; Richard Whitlock; Andre Lamy; David Conen; Sabu Thomas; Christian Mueller; Allan S Jaffe; P J Devereaux

doi:10.1093/clinchem/hvad005

High-sensitivity Troponin I Predicts Major Cardiovascular Events after Non-Cardiac Surgery: A Vascular Events in Non-Cardiac Surgery Patients Cohort Evaluation (VISION) Substudy

Clin Chem. 2023 Apr 28;69(5):492-499. doi: 10.1093/clinchem/hvad005.

Authors

Flavia K Borges^{1

2

3}, Emmanuelle Duceppe^{1

4}, Diane Heels-Ansdell³, Ameen Patel², Daniel I Sessler⁵, Vikas Tandon², Matthew Chan⁶, Rupert Pearse⁷, Sadeesh Srinathan⁸, Amit X Garg^{3

9}, Robert J Sapsford¹⁰, Sandra N Ofori³, Maura Marcucci^{1

2

3}, Peter A Kavsak¹¹, Shirley Pettit¹, Jessica Spence^{1

12}, Emilie Belley-Cote^{1

2

3}, Michael McGillion^{1

13}, Richard Whitlock^{1

14}, Andre Lamy^{1

14}, David Conen^{1

2

3}, Sabu Thomas¹⁵, Christian Mueller¹⁶, Allan S Jaffe¹⁷, P J Devereaux^{1

3}

Affiliations

¹ Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Canada.
² Department of Medicine, McMaster University, Hamilton, Canada.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
⁴ Department of Medicine, University of Montreal, Montreal, Canada.
⁵ Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States.
⁶ Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
⁷ Department of Critical Care, Queen Mary University of London and Barts Health NHS Trust, London, United Kingdom.
⁸ Department of Surgery, University of Manitoba, Winnipeg, Canada.
⁹ Division of Nephrology, London Health Sciences Centre Research Institute, London, Canada.
¹⁰ Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
¹¹ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.
¹² Department of Anesthesia, McMaster University, Hamilton, Canada.
¹³ School of Nursing, McMaster University, Hamilton, Canada.
¹⁴ Department of Surgery, McMaster University, Hamilton, Canada.
¹⁵ Division of Cardiology, University of Rochester School of Medicine, Rochester, New York, United States.
¹⁶ Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
¹⁷ Department of Cardiovascular Diseases, and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, New York, United States.

PMID: 36762424
DOI: 10.1093/clinchem/hvad005

Abstract

Background: Myocardial injury after non-cardiac surgery (MINS), based on measurement of troponin T, is associated with perioperative major adverse cardiovascular events (MACE). We therefore determined the high-sensitivity troponin I (hsTnI) thresholds associated with 30 day MACE after non-cardiac surgery.

Methods: We performed a nested biobank cohort study of 4553 patients from the Vascular Events in Non-Cardiac Surgery Patients Cohort Evaluation (VISION) Study. We measured hsTnI (ADVIA Centaur® hsTnI assay) on postoperative days 1 to 3 in patients ≥45 years undergoing non-cardiac surgery. An iterative Cox proportional hazard model determined peak postoperative hsTnI thresholds independently associated with MACE (i.e., death, myocardial infarction occurring on postoperative day 4 or after, non-fatal cardiac arrest, or congestive heart failure) within 30 days after surgery.

Results: MACE occurred in 89/4545 (2.0%) patients. Peak hsTnI values of <75 ng/L, 75 ng/L to <1000 ng/L, and ≥1000 ng/L were associated with 1.2% (95% CI, 0.9-1.6), 7.1% (95% CI, 4.8-10.5), and 25.9% (95% CI, 16.3-38.4) MACE, respectively. Compared to peak hsTnI <75 ng/L, values 75 ng/L to <1000 ng/L and ≥1000 ng/L were associated with adjusted hazard ratios (aHR) of 4.53 (95% CI, 2.75-7.48) and 16.17 (95% CI, 8.70-30.07), respectively. MACE was observed in 9% of patients with peak hsTnI ≥75 ng/L vs 1% in patients with peak hsTnI <75 ng/L (aHR 5.76; 95% CI, 3.64-9.11). A peak hsTnI ≥75 ng/L was associated with MACE in the presence (aHR 9.35; 95% CI, 5.28-16.55) or absence (aHR 3.99; 95% CI, 2.19-7.25) of ischemic features of myocardial injury.

Conclusion: A peak postoperative hsTnI ≥75 ng/L was associated with >5-fold increase in the risk of 30 days MACE compared to levels <75 ng/L. This threshold could be used for MINS diagnosis when the ADVIA Centaur hsTnI assay is used.Clinicaltrials.gov Registration Number: NCT00512109.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomarkers
Cohort Studies
Heart Failure*
Humans
Myocardial Infarction* / diagnosis
Troponin I

Substances

Troponin I
Biomarkers

Associated data

ClinicalTrials.gov/NCT00512109