Long-term prognostic value of asymptomatic cardiac troponin T elevations in patients after major vascular surgery

Osteoarthritis (OA) is associated with higher cardiovascular mortality risk. High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are well-characterized prognostic cardiac markers. We aimed to describe the changes in biomarkers measured one year apart in a cohort of 347 subjects with OA who underwent hip or knee replacement surgery in 1995/1996 and to analyze the prognostic value of repeated measurements for long-term mortality. During a median follow-up of 19 years, 209 (60.2%) subjects died. Substantial changes in cardiac biomarkers, especially for NT-proBNP, and an independent prognostic value of NT-proBNP for long-term mortality were found for both baseline measurement concentration (hazard ratio (HR) 1.32, 95% confidence interval (CI) (1.13–1.55)) and follow-up measurement concentration (HR 1.39, 95% CI 1.18–1.64) (all HR per standard deviation increase after natural log-transformation). Baseline concentrations were correlated with follow-up concentrations of NT-proBNP and no longer showed prognostic value when included simultaneously in a single model (HR 1.08, 95% CI 0.86–1.37), whereas the estimate for the one-year measurement remained robust (HR 1.31, 95% CI 1.04–1.66). Therefore, no significant additional benefit of repeated NT-proBNP measurements was found in this cohort, facilitating the use of a single NT-proBNP measurement as a stable prognostic marker.

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Superiority of high sensitivity cardiac troponin T vs. I for long-term prognostic value in patients with chest pain; data from the Akershus cardiac Examination (ACE) 3 study

Clinical Biochemistry ◽

10.1016/j.clinbiochem.2019.12.016 ◽

2020 ◽

Vol 78 ◽

pp. 10-17 ◽

Cited By ~ 1

Author(s):

Sjur H. Tveit ◽

Peder L. Myhre ◽

Nils Jakob S. Hoff ◽

Tri M. Le ◽

Ingebjørg Seljeflot ◽

...

Keyword(s):

Chest Pain ◽

Cardiac Troponin ◽

Prognostic Value ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T

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Abstract 14566: Mild Elevation in Cardiac Troponin T is Independently Associated With Long-Term Mortality After Intermediate or High-Risk Vascular Surgery

Circulation ◽

10.1161/circ.132.suppl_3.14566 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Grant W Reed ◽

Samuel Horr ◽

Stephen G Ellis ◽

A. Michael Lincoff ◽

Steven E Nissen ◽

...

Keyword(s):

High Risk ◽

Vascular Surgery ◽

Cardiac Troponin ◽

Troponin T ◽

Risk Index ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Cardiac Troponin T ◽

Long Term Mortality

Introduction: Myocardial injury is a risk factor for adverse outcomes after non-cardiac surgery. However, the prevalence of cardiac troponin T (cTnT) sampling after vascular surgery in real-word practice has not been well studied. Further, whether mild perioperative cTnT elevation is associated with long-term mortality is not established. Methods: This was a retrospective study of 13,196 patients who underwent intermediate or high-risk vascular surgery at a single center from January 1, 2010 - May 1, 2015. Patients were assessed for cTnT sampling within 96 hours of surgery. Cumulative 3 year mortality was stratified by absence of cTnT sampling, a normal value of 0.10 ng/mL. Cox proportional hazards analysis was used to adjust mortality for Revised Cardiac Risk Index (RCRI) score and other patient characteristics. Results: Mean age was 66.2±14.4 years, and 5,357 (40.6%) were female. Troponin was sampled in 3,296 (25.0%) patients, and among those 747 (5.7%) were elevated (positive yield 22.7%). There were 1,858 (14.1%) deaths. On Kaplan-Meier analysis, all-cause mortality was greatest with elevated cTnT (p<0.0001, Figure - A) and was higher across degrees of cTnT elevation (p<0.0001, Figure - B). After adjusting for RCRI score, age, gender, and diabetes, degree of cTnT elevation remained independently associated with mortality (Table). Conclusions: The degree of cTnT elevation independently predicts long-term mortality after vascular surgery. Even mild elevations of cTnT above threshold are associated with heightened risk of mortality, which extends well beyond the acute post-operative period.

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