Evaluation of perioperative high-sensitive cardiac troponin i as a predictive biomarker of major adverse cardiovascular events after noncardiac surgery

ABSTRACT Background: Various studies suggest that perioperative concentrations of high-sensitivity troponins are incremental and predictive factors of a major adverse cardiac event (MACE) and all-cause mortality. Objective: The objective of the study was to evaluate the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) in the development of MACE and all-cause mortality, within 30-days and 1-year follow-up after noncardiac surgery. Methods: In this prospective cohort study, we included men ≥ 45 years and women ≥ 55 years with ≥ 2 cardiovascular risk factors and undergoing intermediate or high-risk noncardiac surgery. Demographic and clinical information was collected from clinical charts. We measured baseline hs-cTnI 24 h before surgery, and its post-operative concentration 24 h after surgery. Results: In the entire sample, 8 patients (8.6%) developed MACE at 30-days follow-up (4 deaths), 12 (12.9%) within the 1st year (7 deaths), and 17 (18.2%) after complete post-surgical follow-up (10 deaths). We observed higher baseline and post-operative concentrations in patients who presented MACE (12 pg/ml vs. 3.5 pg/ml; p = 0.001 and 18.3 pg/ml vs. 5.45 pg/ml; p = 0.009, respectively). The hazard ratios (HRs) calculated by Cox regression analysis between the hs-cTnI baseline concentration and the post-operative development of MACE at 30-days and 1-year were 5.70 (95% confidence interval [CI], 1.10-29.40) with hs-cTnI > 6.2 pg/ml and 12.86 (95% CI, 1.42-116.34) with hs-cTnI > 3.3 pg/ml, respectively. The estimated post-operative HR death risk at 1-year was 14.43 (95% CI, 1.37-151.61) with hs-cTnI > 4.5 pg/ml. Conclusions: Pre-operative hs-cTnI was an independent predictive risk factor for MACE at 30-days and 1-year after noncardiac surgery and for all-cause mortality at 1-year after noncardiac surgery.

Study on value of combination detection of cardiac troponins I and homocysteine in individual diagnosis of non-ST elevation myocardial infarction / 重庆医学

Objective To discuss the effect of the combination detection of cardiac troponin I (cTnI) and homocysteine(Hcy) for increasing the diagnosis and treatment offects of non-ST elevation myocardial infarction (NSTEMI) .Methods The levels of cTnI and Hcy were detected in 47 patients with NSTEMI(NSTEMI group) before and after therapy and 63 healthy individuals(control group) .The detection results were performed the statistical analysis for verifying their value to judge the diagnostic and treatment effect of NSTEMI .Results The levels of cTnI and Hcy were (2 .37 ± 0 .65)ng/mL and(19 .23 ± 2 .94)μmol/L in the NSTEMI group ,which were significantly higher than(0 .33 ± 0 .14)ng/mL and(10 .62 ± 3 .27)μmol/L in the control group ,the differences showing statistical significance (P< 0 .05);the sensitivities of single cTnI and Hcy were 95 .74% and 85 .11% respectively ,and their specificities were 85 .71% and 90 .48% respectively ;the sensitivity and sepecificity of cTnI and Hcy combination detection were risen to 97 .87% and 98 .41% respectively ;after therapy ,the cTnI and Hcy levels in the NSTEMI group were significantly lowered and close to the normal levels .Conclusion The combination detection of cTnI and Hcy can not only be used for the diagno-sis of NSTEMI ,but also has the important significance to the judgment of the therapeutical effect of NSTEMI .