Abstract
Preoperative high-sensitivity cardiac troponin (hs-cTn) above the 99th-percentile upper reference limit (URL) is associated with mortality after noncardiac surgery. This study aimed to evaluate whether preoperative hs-cTn concentrations above the lowest limit of detection (LOD) but below the 99th-percentile URL can predict mortality after noncardiac surgery.From January 2010 to April 2019, a total of 12,415 noncardiac surgical patients with preoperative hs-cTn I below the 99th-percentile URL were enrolled. The patients were divided into two groups according to preoperative hs-cTn I concentration: (1) [hs-cTn] below the LOD (6 ng/L), and (2) mildly elevated [hs-cTn] but below the 99th-percentile URL (40 ng/L). The primary outcome was 30-day mortality. Of the 12,415 patients enrolled, 7958 (64.1%) were in the LOD group whereas 4457 (35.9%) were in the mild elevation group. The incidence of 30-day mortality was significantly greater in the mild elevation group (2.1% vs. 4.0% hazard ratio [HR] 1.73; 95% confidence interval [CI] 1.39–2.16; p < 0.001) in the multivariate analyses. The propensity score matched analyses also produced a similar result (2.6% vs. 4.2% HR 1.61; 95% CI 1.26–2.07; p < 0.001). The threshold at which the risk of mortality increased corresponded to a preoperative hs-cTn I ≥ 12 ng/L. Patients with preoperative hs-cTn I above the LOD and below the 99th-percentile URL had greater 30-day mortality after noncardiac surgery.
Highlights
Preoperative high-sensitivity cardiac troponin above the 99th-percentile upper reference limit (URL) is associated with mortality after noncardiac surgery
Given the 99th-percentile URL provided by the high-sensitivity cardiac troponin immunoassay manufacturer was established using data from healthy individuals, this URL may not be an optimal cut-off value for patients scheduled for surgery
The 12,415 patients were divided into the two groups according to preoperative high-sensitivity cardiac troponin (hs-cTn) I concentration: 7958 (64.1%) patients were in the limit of detection (LOD) group and 4457 (35.9%) patients were in the mild elevation group
Summary
Preoperative high-sensitivity cardiac troponin (hs-cTn) above the 99th-percentile upper reference limit (URL) is associated with mortality after noncardiac surgery. Patients with preoperative hs-cTn I above the LOD and below the 99th-percentile URL had greater 30-day mortality after noncardiac surgery. Abbreviations CI Confidence interval hs-cTn High-sensitivity cardiac troponin HR Hazard ratio IQR Interquartile range URL Upper reference limit. Based on robust clinical relevance, the diagnostic criteria for postoperative myocardial injury after noncardiac surgery (MINS) include the occurrence of postoperative troponin concentrations above the 99th-percentile upper reference limit (URL) within 30 days post-surgery, resulting from myocardial ischemia without the requirement of an ischemic feature[3,4,5]. We aimed to evaluate the prognostic impact of preoperative serum cardiac troponin concentrations above the lowest limit of detection (LOD) but below the 99th-percentile URL
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
