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Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery

Weber, Michael ; Luchner, Andreas ; Manfred, Seeberger ; Mueller, Christian ; Liebetrau, Christoph ; Schlitt, Axel ; Apostolovic, Svetlana ; Jankovic, Radmilo ; Bankovic, Dragic ; Jovic, Marina ; Mitrovic, Veselin ; Nef, Holger ; Mollmann, Helge ; Hamm, Christian W.

In: European Heart Journal, 2013, vol. 34, no. 11, p. 853-862

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    Titel
    • Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery
    Autor
    • Weber, Michael. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
    • Luchner, Andreas. University of Regensburg, Regensburg, Germany
    • Manfred, Seeberger. University of Basel, Basel, Switzerland
    • Mueller, Christian. University of Basel, Basel, Switzerland
    • Liebetrau, Christoph. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
    • Schlitt, Axel. University of Halle, Halle, Germany
    • Apostolovic, Svetlana. Medical Center Nis, Nis, Serbia
    • Jankovic, Radmilo. Medical Center Nis, Nis, Serbia
    • Bankovic, Dragic. University of Kragujevac, Kragujevac, Serbia
    • Jovic, Marina. University of Kragujevac, Kragujevac, Serbia
    • Mitrovic, Veselin. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
    • Nef, Holger. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
    • Mollmann, Helge. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
    • Hamm, Christian W.. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • European Heart Journal, 2013, vol. 34, no. 11, p. 853-862. Oxford University Press
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:293506
    Summary
    Aims We aimed to evaluate the incremental value of high-sensitive troponin T (hsTnT) for risk prediction prior to non-cardiac surgery in comparison with the established revised cardiac index. Methods and results In this prospective, international multicentre observational study, 979 patients prior to non-cardiac surgery were enrolled. The endpoints were in-hospital mortality, the combination of death, acute myocardial infarction, cardiac arrest, cardio-pulmonary resuscitation, and acute decompensated heart failure. Twenty-five patients (2.6%) deceased and 36 (3.7%) of the patients experienced the combined endpoint. Cardiac markers were elevated in those patients who died when compared with survivors (hsTnT: 21 ng/L vs. 7 ng/L; P < 0.001; NT-proBNP: 576 pg/mL vs. 166 pg/mL; P < 0.001). Applying a cut-off for hsTnT of 14 ng/L and for NT-proBNP of 300 pg/mL, those patients with elevated hsTnT had a mortality of 6.9 vs. 1.2% (P < 0.001) and with elevated NT-proBNP 4.8 vs. 1.4% (P = 0.002). The highest AUC of the ROC curve was found for hsTnT as a predictor for mortality of 0.809. In a multivariate Cox regression analyses, hsTnT was the strongest independent predictor for the combined endpoint [HR 2.6 (95% CI: 1.3-5.3); P = 0.01]. Conclusion High-sensitive troponin T provides strong prognostic information in patients undergoing non-cardiac surgery incremental to the widely accepted revised cardiac index