Abstract 9965: Prediction and Diagnosis of Perioperative Myocardial Infarction with High-sensitivity troponin T

Abstract

Introduction The role of high-sensitivity troponin assays in the prediction and diagnosis of perioperative myocardial infarction is unknown.

Methods This is an ancillary study of the Vitamins in Nitrous Oxide (VINO) Trial where 625 patients with or at risk for coronary artery disease undergoing major noncardiac surgery were studied..Plasma hsTnT (Roche) and standard troponin I (Siemens) were measured serially and 12-lead ECGs were obtained.

Results At baseline 75% of patients (455/606) had a measurable preoperative hsTNT and 25% had a hsTnT <3 pg/mL. The median hsTnT was 7.4 pg/mL (IQR 2.3 - 15.2). Postoperatively, 409/568 patients (72%) had an increase in hsTnT (median 2.9 pg/mL; IQR 0 - 7.4) and 159/569 (28%) had no change. The median peak hsTnT was 12.2 pg/mL (IQR 6.1 - 23.0). Peak and delta hsTnT and troponin I measurements were tightly correlated (r= 0.99 and 0.99, respectively). Eighty-two patients (13%) had a clinically relevant postoperative TnI elevation >0.07 ng/mL and 30/605 (5%) had a myocardial infarction. Using the median preoperative hsTnT concentration of 7.4 pg/mL, patients above this level had a nearly 3-fold risk to develop a clinically significant postoperative troponin elevation (odds ratio 2.80, 95% CI: 1.69 - 4.63, p< 0.001) and to develop postoperative myocardial infarction (odds ratio 2.94, 95% CI 1.29 - 6.71, p= 0.007). At 7.4 pg/mL, the sensitivity and specificity for postoperative troponin elevation were 71% and 54% and for postoperative myocardial infarction 73% and 52% (Figure 1).

Conclusions: Preoperative hsTNT concentrations can be detected in most adult patients with or at risk for coronary artery disease before surgery and may be useful in preoperative risk-stratification for postoperative myocardial infarction. Postoperative increase in hsTnT (delta hsTnT) is common among patients with cardiovascular risk factors and may be useful as objective quantification of perioperative myocardial injury.