Incidence and outcomes of perioperative myocardial infarction/injury diagnosed by high-sensitivity cardiac troponin I
Danielle Menosi Gualandro, Christian Puelacher, Giovanna Lurati Buse, Noemi Glarner, Francisco Akira Malta Cardozo, Ronja Vogt, Reka Hidvegi, Célia Maria Cássaro Strunz, Daniel Bolliger, Johanna Gueckel, Pai Ching Yu, Marcel Liffert, Ketina Arslani, Alexandra Prepoudis, Daniela Calderaro, Angelika Hammerer‐Lercher, Andreas Lampart, Luzius A. Steiner, Stefan Schären, Christoph Kindler, Lorenz Guerke, Stefan Osswald, P.J. Devereaux, Bruno Caramelli, Christian Mueller, for the BASEL-PMI Investigators, Stella Marbot, Ivo Strebel, Alessandro Genini, Katharina Rentsch, Jasper Boeddinghaus, Thomas Nestelberger, Karin Wild, Tobias Zimmermann, Alberto J. S. Duarte, Andreas Buser, Nélson De Luccia, Luca Koechlin, Desirée Wussler, J Walter, Velina Widmer, Michael Freese, Pedro López‐Ayala, Raphael Twerenbold, Patrick Badertscher, Esther Seeberger, Thomas Wolff, Edin Mujagić, Arne Mehrkens, Julia Dinort, Gregor Fahrni, Raban Jeger, Christoph Kaiser, Mariana Matheus, Adriana F. Pastana
Abstract
Abstract Background Perioperative myocardial infarction/injury (PMI) diagnosed by high-sensitivity troponin (hs-cTn) T is frequent and a prognostically important complication of non-cardiac surgery. We aimed to evaluate the incidence and outcome of PMI diagnosed using hs-cTnI, and compare it to PMI diagnosed using hs-cTnT. Methods We prospectively included 2455 patients at high cardiovascular risk undergoing 3111 non-cardiac surgeries, for whom hs-cTnI and hs-cTnT concentrations were measured before surgery and on postoperative days 1 and 2. PMI was defined as a composite of perioperative myocardial infarction (PMI Infarct ) and perioperative myocardial injury (PMI Injury ), according to the Fourth Universal Definition of Myocardial Infarction. All-cause mortality was the primary endpoint. Results Using hs-cTnI, the incidence of overall PMI was 9% (95% confidence interval [CI] 8–10%), including PMI Infarct 2.6% (95% CI 2.0–3.2) and PMI Injury 6.1% (95% CI 5.3–6.9%), which was lower versus using hs-cTnT: overall PMI 15% (95% CI 14–16%), PMI Infarct 3.7% (95% CI 3.0–4.4) and PMI Injury 11.3% (95% CI 10.2–12.4%). All-cause mortality occurred in 52 (2%) patients within 30 days and 217 (9%) within 1 year. Using hs-cTnI, both PMI Infarct and PMI Injury were independent predictors of 30-day all-cause mortality (adjusted hazard ratio [aHR] 2.5 [95% CI 1.1–6.0], and aHR 2.8 [95% CI 1.4–5.5], respectively) and, 1-year all-cause mortality (aHR 2.0 [95% CI 1.2–3.3], and aHR 1.8 [95% CI 1.2–2.7], respectively). Overall, the prognostic impact of PMI diagnosed by hs-cTnI was comparable to the prognostic impact of PMI using hs-cTnT. Conclusions Using hs-cTnI, PMI is less common versus using hs-cTnT. Using hs-cTnI, both PMI Infarct and PMI Injury remain independent predictors of 30-day and 1-year mortality. Graphic abstract