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Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery

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dc.contributor.author Devereaux, P. J.
dc.contributor.author Biccard, Bruce M.
dc.contributor.author Sigamani, Alben
dc.contributor.author Xavier, Denis
dc.contributor.author Chan, Matthew T. V.
dc.contributor.author Srinathan, Sadeesh K.
dc.contributor.author Walsh, Michael
dc.contributor.author Abraham, Valsa
dc.contributor.author Pearse, Rupert
dc.contributor.author Wang, C. Y.
dc.contributor.author Sessler, Daniel I.
dc.contributor.author Kurz, Andrea
dc.contributor.author Szczeklik, Wojciech
dc.contributor.author Berwanger, Otavio
dc.contributor.author Villar, Juan Carlos
dc.contributor.author Málaga Rodríguez, Germán Javier
dc.contributor.author Garg, Amit X.
dc.contributor.author Chow, Clara K.
dc.contributor.author Ackland, Gareth
dc.contributor.author Patel, Ameen
dc.contributor.author Borges, Flavia Kessler
dc.contributor.author Belley-Cote, Emilie P.
dc.contributor.author Duceppe, Emmanuelle
dc.contributor.author Spence, Jessica
dc.contributor.author Tandon, Vikas
dc.contributor.author Williams, Colin
dc.contributor.author Sapsford, Robert J.
dc.contributor.author Polanczyk, Carisi A.
dc.contributor.author Tiboni, Maria
dc.contributor.author Alonso-Coello, Pablo
dc.contributor.author Faruqui, Atiya
dc.contributor.author Heels-Ansdell, Diane
dc.contributor.author Lamy, Andre
dc.contributor.author Whitlock, Richard
dc.contributor.author LeManach, Yannick
dc.contributor.author Roshanov, Pavel S.
dc.contributor.author McGillion, Michael
dc.contributor.author Kavsak, Peter
dc.contributor.author McQueen, Matthew J.
dc.contributor.author Thabane, Lehana
dc.contributor.author Rodseth, Reitze N.
dc.contributor.author Buse, Giovanna A. Lurati
dc.contributor.author Bhandari, Mohit
dc.contributor.author Garutti, Ignacia
dc.contributor.author Jacka, Michael J.
dc.contributor.author Schunemann, Holger J.
dc.contributor.author Cortes, Olga Lucia
dc.contributor.author Coriat, Pierre
dc.contributor.author Dvirnik, Nazari
dc.contributor.author Botto, Fernando
dc.contributor.author Pettit, Shirley
dc.contributor.author Jaffe, Allan S.
dc.contributor.author Guyatt, Gordon H.
dc.date.accessioned 2019-01-25T15:02:19Z
dc.date.available 2019-01-25T15:02:19Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4610
dc.description.abstract Importance: Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). Objective: To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). Design, Setting, and Participants: Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013. Exposures: Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement. Main Outcomes and Measures: A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-day mortality of 3% or higher. To determine potential diagnostic criteria for MINS, regression analyses ascertained if postoperative hsTnT elevations required an ischemic feature (eg, ischemic symptom or electrocardiography finding) to be associated with 30-day mortality. Results: Among 21 842 participants, the mean age was 63.1 (SD, 10.7) years and 49.1% were female. Death within 30 days after surgery occurred in 266 patients (1.2%; 95% CI, 1.1%-1.4%). Multivariable analysis demonstrated that compared with the reference group (peak hsTnT <5 ng/L), peak postoperative hsTnT levels of 20 to less than 65 ng/L, 65 to less than 1000 ng/L, and 1000 ng/L or higher had 30-day mortality rates of 3.0% (123/4049; 95% CI, 2.6%-3.6%), 9.1% (102/1118; 95% CI, 7.6%-11.0%), and 29.6% (16/54; 95% CI, 19.1%-42.8%), with corresponding adjusted HRs of 23.63 (95% CI, 10.32-54.09), 70.34 (95% CI, 30.60-161.71), and 227.01 (95% CI, 87.35-589.92), respectively. An absolute hsTnT change of 5 ng/L or higher was associated with an increased risk of 30-day mortality (adjusted HR, 4.69; 95% CI, 3.52-6.25). An elevated postoperative hsTnT (ie, 20 to <65 ng/L with an absolute change ≥5 ng/L or hsTnT ≥65 ng/L) without an ischemic feature was associated with 30-day mortality (adjusted HR, 3.20; 95% CI, 2.37-4.32). Among the 3904 patients (17.9%; 95% CI, 17.4%-18.4%) with MINS, 3633 (93.1%; 95% CI, 92.2%-93.8%) did not experience an ischemic symptom. Conclusions and Relevance: Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality. en_US
dc.language.iso eng
dc.publisher American Medical Association
dc.relation.ispartofseries JAMA
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Aged en_US
dc.subject Middle Aged en_US
dc.subject Prospective Studies en_US
dc.subject Risk Assessment en_US
dc.subject Myocardial Infarction/mortality en_US
dc.subject Myocardial Ischemia/mortality en_US
dc.subject Postoperative Complications en_US
dc.subject Postoperative Period en_US
dc.subject Troponin T/blood en_US
dc.title Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1001/jama.2017.4360
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn 1538-3598


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