05388nas a2200901   4500000000100000008004100001653001100042653001100053653000900064653000900073653001600082653002600098653002400124653002000148653003200168653002400200653002500224653001500249100001500264700001800279700001800297700001700315700001900332700002200351700001800373700001800391700001800409700002100427700002100448700002300469700002000492700001900512700001600531700005700547700001700604700001800621700001100639700001900650700001600669700001600685700001400701700001900715700001600734700001800750700002300768700002300791700001900814700001700833700001700850700002400867700001800891700002400909700001500933700002100948700002100969700001900990700002201009700001701031700002001048700001901068700001901087700001801106700001901124700002001143700002301163700001601186700001801202700001901220700001901239700001901258700001601277700001801293245015601311300001401467490000801481520298301489022001404472       2017                            d10aFemale10aHumans10aAged10aMale10aMiddle Aged10aMyocardial Infarction10aProspective Studies10aRisk Assessment10aPostoperative Complications10aMyocardial Ischemia10aPostoperative Period10aTroponin T1 aChow Clara1 aWalsh Michael1 aBiccard Bruce1 aChan Matthew1 aSigamani Alben1 aSrinathan Sadeesh1 aJacka Michael1 aMalaga German1 aAbraham Valsa1 aBerwanger Otavio1 aPolanczyk Carisi1 aSzczeklik Wojciech1 aSapsford Robert1 aWilliams Colin1 aDevereaux P1 aWriting Committee for the VISION Study Investigators1 aXavier Denis1 aPearse Rupert1 aWang C1 aSessler Daniel1 aKurz Andrea1 aVillar Juan1 aGarg Amit1 aAckland Gareth1 aPatel Ameen1 aBorges Flavia1 aBelley-Cote Emilie1 aDuceppe Emmanuelle1 aSpence Jessica1 aTandon Vikas1 aTiboni Maria1 aAlonso-Coello Pablo1 aFaruqui Atiya1 aHeels-Ansdell Diane1 aLamy Andre1 aWhitlock Richard1 aLeManach Yannick1 aRoshanov Pavel1 aMcGillion Michael1 aKavsak Peter1 aMcQueen Matthew1 aThabane Lehana1 aRodseth Reitze1 aBuse Giovanna1 aBhandari Mohit1 aGarutti Ignacia1 aSchünemann Holger1 aCortes Olga1 aCoriat Pierre1 aDvirnik Nazari1 aBotto Fernando1 aPettit Shirley1 aJaffe Allan1 aGuyatt Gordon00aAssociation of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery.  a1642-16510 v3173 a<p>
<b>Importance: </b>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).
</p>

<p>
<b>Objective: </b>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).
</p>

<p>
<b>Design, Setting, and Participants: </b>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.
</p>

<p>
<b>Exposures: </b>Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement.
</p>

<p>
<b>Main Outcomes and Measures: </b>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.
</p>

<p>
<b>Results: </b>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 &lt;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 &lt;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.
</p>

<p>
<b>Conclusions and Relevance: </b>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.
</p>
  a1538-3598