Korean Circ J.  2020 Oct;50(10):925-937. 10.4070/kcj.2020.0088.

Mildly Elevated Cardiac Troponin below the 99th-Percentile Upper Reference Limit after Noncardiac Surgery

• Park J
• Hyeon CW
• Lee SH
• Kim J
• Kwon JH
• Yang K
• Min JJ
• Lee JH
• Lee SM
• Yang JH
• Song YB
• Hahn JY
• Choi Jh
• Choi SH
• Kim K
• Ahn J
• Gwon HC

• KMID: 2507010
• DOI: http://doi.org/10.4070/kcj.2020.0088

Abstract

Background and Objectives
In patients with perioperative cardiac troponin (cTn) I below the 99th-percentile upper range of limit (URL), mortality according to cTn I level has not been fully evaluated. This study evaluated the association between postoperative cTn I level above the lowest limit of detection but within the 99th-percentile URL and 30-day mortality after noncardiac surgery.
Methods
Patients with cTn I values below the 99th-percentile URL during the perioperative period were divided into a no-elevation group with cTn I at the lowest limit of detection (6 ng/L) and a minor elevation group with cTn I elevation below the 99th percentile URL (6 ng/L < cTn I < 40 ng/L). The primary outcome was 30-day mortality.
Results
Of the 5,312 study participants, 2,582 (48.6%) were included in the no-elevation group and 2,730 (51.4%) were included in the minor elevation group. After propensity scorematching, the minor elevation group showed significantly increased 30-day mortality (0.5% vs. 2.3%; hazard ratio, 4.30; 95% confidence interval, 2.23–8.29; p<0.001). The estimated cutoff value of cTn I to predict 30-day mortality was 6 ng/L with the area under the receiver operating characteristic curve 0.657.
Conclusions
A mild elevation of cTn I within the 99th-percentile URL after noncardiac surgery was significantly associated with increased 30-day mortality as compared with the lowest limit of detection.

Keyword

Generalsurgery; Troponin; Mortality

Figure

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  Figure 1 The Kaplan-Meier curves of the entire population. Graph (A) for 30-day mortality and graph (B) for in-hospital mortality during 30 days.

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  Figure 2 The Kaplan-Meier curves of the propensity score-matched population. Graph (A) for 30-day mortality and graph (B) for in-hospital mortality during 30 days.

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  Figure 3 The Kaplan-Meier curves of 30-day mortality according to three groups: no-elevation group, below the median value group, and above the median value group. Additionally, values (A) for the entire population and (B) for the propensity score-matched population can be noted.

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  Figure 4 Receiver operating characteristic curves for postoperative cardiac troponin within the 99th-percentile upper reference limit associated with 30-day mortality.PV+ = positive predictive value; PV− = negative predictive value; Sens = sensitivity; Spec = specificity.

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