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Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery

Gualandro, Danielle M. and Puelacher, Christian and LuratiBuse, Giovanna and Lampart, Andreas and Strunz, Celia and Cardozo, Francisco A. and Yu, Pai C. and Jaffe, Allan S. and Barac, Sanela and Bock, Lukas and Badertscher, Patrick and du Fay de Lavallaz, Jeanne and Marbot, Stella and Sazgary, Lorraine and Bolliger, Daniel and Rentsch, Katharina and Twerenbold, Raphael and Hammerer-Lercher, Angelika and Melo, Edielle S. and Calderaro, Daniela and Duarte, Alberto Js and de Luccia, Nelson and Caramelli, Bruno and Mueller, Christian. (2018) Comparison of high-sensitivity cardiac troponin I and T for the prediction of cardiac complications after non-cardiac surgery. American heart journal, 203. pp. 67-73.

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Official URL: https://edoc.unibas.ch/71135/

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Abstract

We aimed to directly compare preoperative high-sensitivity cardiac troponin (hs-cTn) I and T concentration for the prediction of major cardiac complications after non-cardiac surgery.; We measured hs-cTnI and hs-cTnT preoperatively in a blinded fashion in 1022 patients undergoing non-cardiac surgery. The primary endpoint was a composite of major cardiac complications including cardiac death, cardiac arrest, myocardial infarction, clinically relevant arrhythmias, and acute heart failure within 30 days. We hypothesized that the type of surgery may impact on the predictive accuracy of hs-cTnI/T and stratified all analyses according to the type of surgery.; Major cardiac complications occurred in 108 (11%) patients, 58/243 (24%) patients undergoing vascular surgery and 50/779 (6%, P < .001) patients undergoing non-vascular surgery. Using regulatory-approved 99th percentile cut-off concentrations, preoperative hs-cTnI elevations were less than one-fifth as common as preoperative hs-cTnT elevations (P < .001). Among patients undergoing vascular surgery, preoperative hs-cTnI concentrations, but not hs-cTnT, was an independent predictor of cardiac complications (adjusted odds ratio (aOR) 1.5, 95% confidence interval (95% CI) 1.0-2.1). The area under the receiver-operating characteristics curve (AUC) was 0.67 (95% CI, 0.59-0.75) for hs-cTnI versus 0.59 (95% CI 0.51-0.67, P = .012) for hs-cTnT. In contrast, among patients undergoing non-vascular surgery both preoperative hs-cTnI and hs-cTnT were independent predictors of the primary endpoint (aOR 1.6, 95% CI 1.3-2.0, and aOR 3.0, 95% CI 2.0-4.6, respectively) and showed higher predictive accuracy (AUC 0.77, 95% CI, 0.71-0.83, and 0.79, 95% CI 0.73-0.85, P = ns).; Preoperative hs-cTnI and hs-cTnT concentrations predict major cardiac complications after non-vascular surgery, while, in patients undergoing vascular surgery, hs-cTnI may have better accuracy.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Müller, Christian
Item Type:Article, refereed
Article Subtype:Research Article
ISSN:1097-6744
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:09 Apr 2020 14:29
Deposited On:09 Apr 2020 14:29

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