Cardiac troponin levels linked to increased risk for 30-day mortality substantially higher than thresholds cited for periprocedural myocardial injury
TUESDAY, March 8, 2022 (HealthDay News) — For patients undergoing cardiac surgery, the lowest threshold values of high-sensitivity cardiac troponin I associated with increased rates of death from any cause and major vascular complications at 30 days after surgery are markedly higher than the threshold values currently recommended in consensus statements for the definition of clinically important periprocedural myocardial injury, according to a study published in the March 3 issue of the New England Journal of Medicine.
P.J. Devereaux, M.D., Ph.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues conducted an international prospective cohort study involving patients aged 18 years or older who underwent cardiac surgery. At three to 12 hours after surgery and on days 1, 2, and 3 after surgery, high-sensitivity cardiac troponin I measurements were obtained. Cox analyses were performed to explore the relationship between peak troponin measurements and 30-day mortality.
The researchers found that 2.1 percent of the 13,862 patients included in the study died within 30 days after surgery. The threshold troponin level, measured within one day after surgery, which was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days, was 5,670 ng per liter among patients who underwent isolated coronary artery bypass grafting or aortic valve replacement or repair — a level that was 218 times the upper reference limit. The corresponding threshold troponin level was 12,981 ng per liter among patients who underwent other cardiac surgery — a level 499 times the upper reference limit.
“For many cardiac surgeons and clinical cardiologists, this study will confirm the impression that large troponin elevations are expected after routine cardiac surgery, correlate poorly with clinically evident complications, and remain difficult to interpret and use in determining patient care,” write the authors of an accompanying editorial.
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