Devereaux is a cardiologist with a master's degree in clinical epidemiology and a PhD in clinical epidemiology. He is the Director of McMaster University's Division of Perioperative Care. He is the Scientific Leader of the Population Health Research Institute's Anesthesiology, Perioperative Medicine, and Surgical Research Group. In this podcast Dr. Devereaux discusses High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality
The consensus guidelines for cardiac troponin elevation thresholds for the definition of perioperative myocardial infarction and clinically relevant periprocedural myocardial damage in patients having cardiac surgery range from >10 times to >70 times the assay's upper reference limit. These recommendations are based on a little amount of evidence.
We conducted an international prospective cohort research with patients aged 18 and up who had undergone heart surgery. Measurements of high-sensitivity cardiac troponin I (upper reference limit, 26 ng per liter) were taken 3 to 12 hours after surgery, as well as on days 1, 2, and 3. We used a regression spline to investigate the link between peak troponin values and 30-day mortality, adjusted for European System for Cardiac Operative Risk Evaluation II scores (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex).
296 (2.1%) of the 13,862 participants in the study died within 30 days of their surgery. The threshold troponin level associated with an adjusted hazard ratio of more than 1.00 for death within 30 days among patients who underwent isolated coronary artery bypass grafting or aortic valve replacement or repair was 5670 ng per liter (95 percent confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. The equivalent threshold troponin level in patients who had previous cardiac surgery was 12,981 ng per liter (95 percent CI, 2673 to 16,591), which is 499 times the upper reference limit.
After cardiac surgery, the levels of high-sensitivity troponin I that were linked to an elevated risk of death within 30 days were significantly greater than the values currently used to identify clinically significant periprocedural myocardial damage. (VISION Cardiac Surgery ClinicalTrials.gov number: NCT01842568. opens in new tab; funded by the Canadian Institutes of Health Research and others.)