High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality
Author
Devereaux, P.J.Lamy, Andre
Chan, Matthew T.V.
Allard, René V.
Lomivorotov, Vladimir V.
Landoni, Giovanni
Zheng, Hong
Paparella, Domenico
McGillion, Michael H.
Belley-Côté, Emilie P.
Parlow, Joel L.
Underwood, Malcolm J.
Wang, Chew Yin
Dvirnik, Nazari
Abubakirov, Marat
Fominskiy, Evgeny
Choi, Stephen
Fremes, Stephen
Monaco, Fabrizio
Urrútia, Gerard
Maestre, Marialuz
Hajjar, Ludhmila A.
Hillis, Graham S.
Mills, Nicholas L.
Margari, Vito
Mills, Joseph D.
Billing, J. Stephen
Methangkool, Emily
Polanczyk, Carisi A.
Sant’Anna, Roberto
Shukevich, Dmitry
Conen, David
Kavsak, Peter A.
McQueen, Matthew J.
Brady, Katheryn
Spence, Jessica
Le Manach, Yannick
Mian, Rajibul
Lee, Shun Fu
Bangdiwala, Shrikant I.
Hussain, Sara
Borges, Flavia K.
Pettit, Shirley
Vincent, Jessica
Guyatt, Gordon H.
Yusuf, Salim
Alpert, Joseph S.
White, Harvey D.
Whitlock, Richard P.
Affiliation
University of Arizona, College of MedicineIssue Date
2022-03-03
Metadata
Show full item recordPublisher
Massachusetts Medical SocietyCitation
Devereaux, P. J., Lamy, A., Chan, M. T. V., Allard, R. V., Lomivorotov, V. V., Landoni, G., Zheng, H., Paparella, D., McGillion, M. H., Belley-Côté, E. P., Parlow, J. L., Underwood, M. J., Wang, C. Y., Dvirnik, N., Abubakirov, M., Fominskiy, E., Choi, S., Fremes, S., Monaco, F., … the VISION Cardiac Surgery Investigators. (2022). High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality. New England Journal of Medicine.Journal
New England Journal of MedicineRights
Copyright © 2022 Massachusetts Medical Society.Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.Abstract
BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.Note
6 month embargo; published 3 March 2022ISSN
0028-4793EISSN
1533-4406PubMed ID
35235725Version
Final published versionSponsors
Instituto de Salud Carlos IIIae974a485f413a2113503eed53cd6c53
10.1056/nejmoa2000803