Abstract 14447: Novel Metrics for High Sensitivity-Cardiac Troponin T Improves Diagnosis of Missed Perioperative Myocardial Infarction Events
Introduction: High-sensitivity cardiac troponin (hscTn) assays can detect baseline values in perioperative patients, allowing comparison of relative and absolute changes. Change metrics for hscTn have been advocated for the diagnosis of acute MI, however, there is no evidence for the diagnosis of perioperative myocardial injury or infarction (MI).
Methods: We retrospectively compared several hscTnT metrics for diagnosing perioperative MI, according to the Third Universal Definition, in 607 high cardiovascular risk, non-cardiac surgery patients from the Vitamins in Nitrous Oxide study. Serial 12-lead ECGs, standard cTnI, and hscTnT were obtained preoperatively and up to postoperative day 3 for each patient. The ECGs were read by blinded clinicians and adjudicated by the PI for ischemic changes. All charts, for patients diagnosed with MI by these novel metrics, were further reviewed by the PI to identify real vs. missed events. Adjusted Cox regression was performed to assess association of mortality and each MI diagnostic metric.
Results: Postop contemporary cTnI elevation above the 99th percentile was observed in 82 patients (14%) and 31 patients (5%) had MI, compared to hscTnT elevation above the 99th percentile in 393 patients (65%) and 64 MI patients (11%). Of these 64 patients, 25 (39%) were missed MI events. (Table 1) Mortality was increased up to 4-fold in the short-term for a positive diagnosis of MI. (Table 2)
Conclusions: hscTn assays can identify more patients with MI events and may allow earlier intervention to improve short -term mortality.
Author Disclosures: J.C. Brown: None. S. Rao: None. E. Samaha: None. M.A. Helwani: None. F. Brown: None. F.S. Apple: Research Grant; Modest; Abbott, Siemens, Ortho-Clinical Diagnostics, Roche. Consultant/Advisory Board; Modest; Instrumentation Laboratories, Alere, T2 Biosystems. M.G. Scott: Other Research Support; Modest; Siemens Diagnostics, Abbott Diagnostics, Instrumentation Laboratories. Consultant/Advisory Board; Modest; Instrumentation Laboratories, Becton- Dickinson. A.S. Jaffe: Consultant/Advisory Board; Modest; Beckman, Ortho, Abbott, Alere, Critical Diagnostics, Roche, Amgen, theHeart.org. P. Nagele: Other Research Support; Modest; Roche, Abbott.
- © 2016 by American Heart Association, Inc.