High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality

the VISION Cardiac Surgery Investigators

doi:10.1056/NEJMoa2000803

High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality

the VISION Cardiac Surgery Investigators

Research output: Contribution to journal › Article › peer-review

85 Scopus citations

Abstract

BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.

Original language	English (US)
Pages (from-to)	827-836
Number of pages	10
Journal	New England Journal of Medicine
Volume	386
Issue number	9
DOIs	https://doi.org/10.1056/NEJMoa2000803
State	Published - Mar 3 2022
Externally published	Yes

ASJC Scopus subject areas

General Medicine

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10.1056/NEJMoa2000803

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@article{51e54a36199c4a418685fa31287fcadb,

title = "High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality",

abstract = "BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.",

author = "{the VISION Cardiac Surgery Investigators} and Devereaux, {P. J.} and Andre Lamy and Chan, {Matthew T.V.} and Allard, {Ren{\'e} V.} and Lomivorotov, {Vladimir V.} and Giovanni Landoni and Hong Zheng and Domenico Paparella and McGillion, {Michael H.} and Belley-C{\^o}t{\'e}, {Emilie P.} and Parlow, {Joel L.} and Underwood, {Malcolm J.} and Wang, {Chew Yin} and Nazari Dvirnik and Marat Abubakirov and Evgeny Fominskiy and Stephen Choi and Stephen Fremes and Fabrizio Monaco and Gerard Urr{\'u}tia and Marialuz Maestre and Hajjar, {Ludhmila A.} and Hillis, {Graham S.} and Mills, {Nicholas L.} and Vito Margari and Mills, {Joseph D.} and Billing, {J. Stephen} and Emily Methangkool and Polanczyk, {Carisi A.} and Roberto Sant'Anna and Dmitry Shukevich and David Conen and Kavsak, {Peter A.} and McQueen, {Matthew J.} and Katheryn Brady and Jessica Spence and {Le Manach}, Yannick and Rajibul Mian and Lee, {Shun Fu} and Bangdiwala, {Shrikant I.} and Sara Hussain and Borges, {Flavia K.} and Shirley Pettit and Jessica Vincent and Guyatt, {Gordon H.} and Salim Yusuf and Alpert, {Joseph S.} and White, {Harvey D.} and Whitlock, {Richard P.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2022 Massachusetts Medical Society.",

year = "2022",

month = mar,

day = "3",

doi = "10.1056/NEJMoa2000803",

language = "English (US)",

volume = "386",

pages = "827--836",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "9",

}

TY - JOUR

T1 - High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality

AU - the VISION Cardiac Surgery Investigators

AU - Devereaux, P. J.

AU - Lamy, Andre

AU - Chan, Matthew T.V.

AU - Allard, René V.

AU - Lomivorotov, Vladimir V.

AU - Landoni, Giovanni

AU - Zheng, Hong

AU - Paparella, Domenico

AU - McGillion, Michael H.

AU - Belley-Côté, Emilie P.

AU - Parlow, Joel L.

AU - Underwood, Malcolm J.

AU - Wang, Chew Yin

AU - Dvirnik, Nazari

AU - Abubakirov, Marat

AU - Fominskiy, Evgeny

AU - Choi, Stephen

AU - Fremes, Stephen

AU - Monaco, Fabrizio

AU - Urrútia, Gerard

AU - Maestre, Marialuz

AU - Hajjar, Ludhmila A.

AU - Hillis, Graham S.

AU - Mills, Nicholas L.

AU - Margari, Vito

AU - Mills, Joseph D.

AU - Billing, J. Stephen

AU - Methangkool, Emily

AU - Polanczyk, Carisi A.

AU - Sant'Anna, Roberto

AU - Shukevich, Dmitry

AU - Conen, David

AU - Kavsak, Peter A.

AU - McQueen, Matthew J.

AU - Brady, Katheryn

AU - Spence, Jessica

AU - Le Manach, Yannick

AU - Mian, Rajibul

AU - Lee, Shun Fu

AU - Bangdiwala, Shrikant I.

AU - Hussain, Sara

AU - Borges, Flavia K.

AU - Pettit, Shirley

AU - Vincent, Jessica

AU - Guyatt, Gordon H.

AU - Yusuf, Salim

AU - Alpert, Joseph S.

AU - White, Harvey D.

AU - Whitlock, Richard P.

PY - 2022/3/3

Y1 - 2022/3/3

N2 - BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.

AB - BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.

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UR - http://www.scopus.com/inward/citedby.url?scp=85126116030&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa2000803

DO - 10.1056/NEJMoa2000803

M3 - Article

C2 - 35235725

AN - SCOPUS:85126116030

SN - 0028-4793

VL - 386

SP - 827

EP - 836

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 9

ER -

High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality

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