Predictive power of high sensitivity troponin T for adverse cardiovascular events in major non-cardiac surgery: Predictor power of hs TnT for adverse cariovascular events in mayor non-cardiac surgery

Abstract

Introduction Existing evidence suggests that even small increases in cTnT in the perioperative period reflect clinically relevant myocardial injury with worsened cardiac prognosis and outcome. European Society of Cardiology (ESC) and European Society of Anaesthesiology (ESA) have proposed a new and comprehensive way to evaluate perioperative cardiac risk. The aim of our study is to evaluate the usefulness of cardiac troponin T (TnT) measured by a new high-sensitive troponin T assay (hsTnT) for risk stratification of patients undergoing non-cardiac surgery. Methods This prospective, single center, observational study enrolled 91 patients undergoing major non-cardiac surgery. A total of 91 patients were recruited between September and December 2013 at Surgical Clinics in Clinical Center Nis, Serbia. Inclusion criteria were major non-cardiac surgery (abdominal, thoracical, orthopaedic and vascular surgery) in general anaesthesia, an age >55 years and at least one of the following cardiovascular risk factors-diabetes mellitus, hypertension, hyperlipidaemia, active smoking, or a family history of cardiac disease. Exclusion criteria were emergent surgery and the disability to understand or to sign informed consent. Results Within 14 days, 14 patients died in the tested population (17.30%). The concentrations of hsTNT (Table 2) was statistically significantly higher in deceased patients (p=0.016). The patients that died were statistically significantly more often admitted to intensive care units (Fisher's test p=0.034).). ROC curve analysis with respect to fatal outcome has shown that hs TnT has the power discrimination potential (AUC 0.713, p=0.016). Conclusion Biomarkers not only serve as traditional predictors of prognosis, they can also help to identify high-risk patients who need closer monitoring and more aggressive therapy.

Keywords

• troponin
• non cradiac surgery
• biomarkers