June 5th, 2012

Troponin T Test Helps Assess Mortality Risk Following Noncardiac Surgery

A new study in JAMA finds that postoperative troponin T (TnT) tests can independently improve 30-day-mortality risk assessment among patients who have undergone noncardiac surgery.

The VISION (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation) study investigators evaluated the prognostic power of postoperative fourth-generation TnT testing in 15,133 patients. Overall mortality at 30 days was 1.9%.

Some 11.6% of patients had peak TnT values greater than 0.02 ng/mL. These patients had an increased risk for death at 30 days:

  • TnT <0.01 ng/mL (reference group): 1% mortality at 30 days
  • TnT 0.02 ng/mL: 4.0%, adjusted hazard ratio 2.41 (1.33-3.77)
  • TnT 0.03-0.29 ng/mL: 9.3%, HR 5.00 (3.72-6.76)
  • TnT >0.30 ng/mL: 16.9%, HR 10.48 (6.25-16.62)
The VISION investigators report that peak TnT value was the strongest predictor of 30-day mortality. A population- attributable risk analysis found that 41.8% of deaths were explained by elevated TnT levels. The findings suggest that postoperative patients with elevated TnT levels may benefit from aspirin and statin therapy, but this strategy has not been tested in clinical trials, the authors note. The investigators conclude that “clinical trials are needed to establish whether interventions can alter patients’ risk of death based on an elevated troponin measurement after surgery.”

One Response to “Troponin T Test Helps Assess Mortality Risk Following Noncardiac Surgery”

  1. Karen Politis, MD says:

    Wow! A gut reaction of an old anesthesiologist: this study sells owls to Athens (the Greek version of snow to the eskimoes). A peroperative myocardial infarction is scary, even though the mortality has gone down in the past decades. Of course the size of the infarct, and the release of troponin, correlates with mortality. As to elevated troponin due to other primary pathology, it still means that the poor heart is having a hard time!