High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality
Por:
Devereaux, PJ, Lamy, A, Chan, MTV, Allard, RV, Lomivorotov, VV, Landoni, G, Zheng, H, Paparella, D, McGillion, MH, Belley-Cote, EP, Parlow, JL, Underwood, MJ, Wang, CY, Dvirnik, N, Abubakirov, M, Fominskiy, E, Choi, S, Fremes, S, Monaco, F, Urrutia, G, Maestre, M, Hajjar, LA, Hillis, GS, Mills, NL, Margari, V, Mills, JD, Billing, JS, Methangkool, E, Polanczyk, CA, Sant'Anna, R, Shukevich, D, Conen, D, Kavsak, PA, McQueen, MJ, Brady, K, Spence, J, Le Manach, Y, Mian, R, Lee, SF, Bangdiwala, SI, Hussain, S, Borges, FK, Pettit, S, Vincent, J, Guyatt, GH, Yusuf, S, Alpert, JS, White, HD, Whitlock, RP
Publicada:
3 mar 2022
Resumen:
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. (Funded by the Canadian Institutes of Health Research and others; VISION Cardiac Surgery ClinicalTrials.gov number, NCT01842568.)
Filiaciones:
Devereaux, PJ:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Lamy, A:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Chan, MTV:
Chinese Univ Hong Kong, Hong Kong, Peoples R China
Allard, RV:
Queens Univ, Kingston, ON, Canada
Lomivorotov, VV:
E Meshalkin Natl Med Res Ctr, Novosibirsk, Russia
Novosibirsk Stare Univ, Novosibirsk, Russia
Landoni, G:
IRCCS San Raffaele Sci Inst, Milan, Italy
Univ Vita Salute San Raffaele, Milan, Italy
Zheng, H:
Xinjiang Med Univ, Affiliated Hosp 1, Urumqi, Peoples R China
Paparella, D:
Univ Foggia, Foggia, Italy
Santa Maria Hosp GVM Care & Res, Bari, Italy
McGillion, MH:
McMaster Univ, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Belley-Cote, EP:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Parlow, JL:
Queens Univ, Kingston, ON, Canada
Underwood, MJ:
Chinese Univ Hong Kong, Hong Kong, Peoples R China
Wang, CY:
Univ Malaya, Kuala Lumpur, Malaysia
Dvirnik, N:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Abubakirov, M:
E Meshalkin Natl Med Res Ctr, Novosibirsk, Russia
Fominskiy, E:
IRCCS San Raffaele Sci Inst, Milan, Italy
Choi, S:
Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada
Univ Toronto, Toronto, ON, Canada
Fremes, S:
Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada
Univ Toronto, Toronto, ON, Canada
Monaco, F:
IRCCS San Raffaele Sci Inst, Milan, Italy
Univ Vita Salute San Raffaele, Milan, Italy
Urrutia, G:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Inst Invest Biomed St Pau CIBERESP, Barcelona, Spain
Maestre, M:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Hajjar, LA:
Univ Sao Paulo, Fac Med, Hosp Clin, Inst Coracao, Sao Paulo, Brazil
Hillis, GS:
Royal Perth Hosp, Perth, WA, Australia
Univ Western Australia, Perth, WA, Australia
Mills, NL:
Univ Edinburgh, Edinburgh, Midlothian, Scotland
Margari, V:
Santa Maria Hosp GVM Care & Res, Bari, Italy
Mills, JD:
Liverpool Heart & Chest Hosp NHS Fdn Trust, Liverpool, Merseyside, England
Billing, JS:
Royal Wolverhampton NHS Trust, Wolverhampton, England
Methangkool, E:
Univ Calif Los Angeles, Los Angeles, CA USA
Polanczyk, CA:
Hosp Moinhos Vento, Porto Alegre, RS, Brazil
Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil
Sant'Anna, R:
Inst Cardiol Rio Grande Do Sul, Porto Alegre, RS, Brazil
Shukevich, D:
Res Inst Complex Issues Cardiovasc Dis, Kemerovo, Russia
Conen, D:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Kavsak, PA:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
McQueen, MJ:
McMaster Univ, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Brady, K:
Populat Hlth Res Inst, Hamilton, ON, Canada
Spence, J:
McMaster Univ, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Le Manach, Y:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Mian, R:
McMaster Univ, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Lee, SF:
McMaster Univ, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Bangdiwala, SI:
McMaster Univ, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Hussain, S:
McMaster Univ, Hamilton, ON, Canada
Borges, FK:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Pettit, S:
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Vincent, J:
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Guyatt, GH:
McMaster Univ, Hamilton, ON, Canada
Yusuf, S:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Alpert, JS:
Univ Arizona, Coll Med, Tucson, AZ USA
White, HD:
Auckland City Hosp, Auckland, New Zealand
Univ Auckland, Auckland, New Zealand
Whitlock, RP:
McMaster Univ, Hamilton, ON, Canada
Hamilton Hlth Sci, Hamilton, ON, Canada
Populat Hlth Res Inst, Hamilton, ON, Canada
Green Published, Green
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