Incidence and outcomes of perioperative myocardial infarction/injury diagnosed by high-sensitivity cardiac troponin I

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Gualandro, Danielle M. ^{[1, 2, 3]} ; Puelacher, Christian ^{[1, 2]} ; Lurati Buse, Giovanna ^[4] ; Glarner, Noemi ^{[1, 2]} ; Cardozo, Francisco A. ^[3] ; Vogt, Ronja ^{[1, 2]} ; Hidvegi, Reka ^{[1, 2]} ; Strunz, Celia ^[5] ; Bolliger, Daniel ^[6] ; Gueckel, Johanna ^{[1, 2]} ; Yu, Pai C. ^[3] ; Liffert, Marcel ^{[1, 2, 6]} ; Arslani, Ketina ^{[1, 2]} ; Prepoudis, Alexandra ^{[1, 2]} ; Calderaro, Daniela ^[3] ; Hammerer-Lercher, Angelika ^[7] ; Lampart, Andreas ^[6] ; Steiner, Luzius A. ^{[8, 9]} ; Schaeren, Stefan ^[10] ; Kindler, Christoph ^[11] ; Guerke, Lorenz ^[12] ; Osswald, Stefan ^{[1, 2]} ; Devereaux, P. J. ^[13] ; Caramelli, Bruno ^[3] ; Mueller, Christian ^{[1, 2]} ; Marbot, Stella ; Strebel, Ivo ; Genini, Alessandro ; Rentsch, Katharina ; Boeddinghaus, Jasper ; Nestelberger, Thomas ; Wild, Karin ; Zimmermann, Tobias ; Duarte, Alberto J. S. ; Buser, Andreas ; de Luccia, Nelson ; Koechlin, Luca ; Wussler, Desiree ; Walter, Joan ; Widmer, Velina ; Freese, Michael ; Lopez-Ayala, Pedro ; Twerenbold, Raphael ; Badertscher, Patrick ; Seeberger, Esther ; Wolff, Thomas ; Mujagic, Edin ; Mehrkens, Arne ; Dinort, Julia ; Fahrni, Gregor ; Jeger, Raban ; Kaiser, Christoph ; Matheus, Mariana ; Pastana, Adriana F. ; Investigators, BASEL PMI

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^[1] Univ Basel, Univ Hosp Basel, Dept Cardiol, Spitalstr 2, CH-4056 Basel - Switzerland

^[2] Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel CRIB, Spitalstr 2, CH-4056 Basel - Switzerland

^[3] Univ Sao Paulo, Sch Med, Heart Inst InCor, Interdisciplinary Med Cardiol Unit, Cardiol Dept, Sao Paulo - Brazil

^[4] Univ Hosp Dusseldorf, Dept Anesthesiol, Dusseldorf - Germany

^[5] Univ Sao Paulo, Sch Med, Heart Inst InCor, Lab Med, Sao Paulo - Brazil

^[6] Univ Basel, Univ Hosp Basel, Dept Anesthesiol, Basel - Switzerland

^[7] Cantonal Hosp Aarau, Dept Lab Med, Aarau - Switzerland

^[8] Univ Basel, Dept Lab Med, Basel - Switzerland

^[9] Univ Basel, Dept Clin Res, Basel - Switzerland

^[10] Univ Hosp Basel, Dept Spinal Surg, Basel - Switzerland

^[11] Cantonal Hosp Aarau, Dept Anesthesiol, Aarau - Switzerland

^[12] Univ Basel, Univ Hosp Basel, Dept Vasc Surg, Basel - Switzerland

^[13] McMaster Univ, Populat Hlth Res Inst, David Braley Cardiac Vasc & Stroke Res Inst, Hamilton Gen Hosp, Anesthesiol Perioperat Med & Su, Hamilton, ON - Canada

• Tipo de documento: Artigo Científico
• Fonte: Clinical Research in Cardiology; v. 110, n. 9, SI, p. 1450-1463, SEP 2021.
• Citações Web of Science: 0

Resumo

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 (PMIInfarct) and perioperative myocardial injury (PMIInjury), 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 PMIInfarct 2.6% (95% CI 2.0-3.2) and PMIInjury 6.1% (95% CI 5.3-6.9%), which was lower versus using hs-cTnT: overall PMI 15% (95% CI 14-16%), PMIInfarct 3.7% (95% CI 3.0-4.4) and PMIInjury 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 PMIInfarct and PMIInjury 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 PMIInfarct and PMIInjury remain independent predictors of 30-day and 1-year mortality. {[}GRAPHICS] . (AU)

• Processo FAPESP: 15/23731-6 - Avaliação da relação entre elevações isoladas de troponinas ultra-sensíveis e eventos cardiovasculares após operações vasculares arteriais
• Beneficiário: Danielle Menosi Gualandro
• Modalidade de apoio: Auxílio à Pesquisa - Regular