The relative merits of using a high-sensitivity cardiac Troponin T assay compared to a nonhigh-sensitivity troponin T assay after noncardiac surgery

Flavia K Borges; Daniel I Sessler; Maria Tiboni; Ameen Patel; Yannick LeManach; Diane Heels-Ansdell; Sadeesh Srinathan; Chew Yin Wang; Clara Chow; Emmanuelle Duceppe; Peter Kavsak; Sandra N Ofori; Shirley Pettit; Otavio Berwanger; Andrea Kurz; Alparslan Turan; Ana Claudia Tonelli; P J Devereaux; VISION Study Investigators

doi:10.1016/j.ahj.2024.05.020

The relative merits of using a high-sensitivity cardiac Troponin T assay compared to a nonhigh-sensitivity troponin T assay after noncardiac surgery

Am Heart J. 2024 Sep:275:45-52. doi: 10.1016/j.ahj.2024.05.020. Epub 2024 Jun 6.

Authors

Flavia K Borges¹, Daniel I Sessler², Maria Tiboni³, Ameen Patel³, Yannick LeManach⁴, Diane Heels-Ansdell⁵, Sadeesh Srinathan⁶, Chew Yin Wang⁷, Clara Chow⁸, Emmanuelle Duceppe⁹, Peter Kavsak¹⁰, Sandra N Ofori¹¹, Shirley Pettit¹², Otavio Berwanger¹³, Andrea Kurz¹⁴, Alparslan Turan¹⁵, Ana Claudia Tonelli¹⁶, P J Devereaux⁴; VISION Study Investigators

Affiliations

¹ Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. Electronic address: [email protected].
² Department of Outcomes Research, Cleveland Clinic, Cleveland, USA.
³ Department of Medicine, McMaster University, Hamilton, Canada.
⁴ Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
⁶ Department of Surgery, University of Manitoba, Winnipeg, Canada.
⁷ Department of Anaesthesiology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
⁸ Department of Cardiology, Westmead Applied Research Centre (WARC), University of Sydney, Westmead, New South Wales, Australia; Westmead Hospital, Westmead, New South Wales, Australia.
⁹ Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Canada; Department of Medicine, University of Montreal, Montreal, Canada.
¹⁰ Department of Pathology and Molecular Medicine, McMaster University.
¹¹ Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada.
¹² Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Canada.
¹³ George Institute for Global Health UK and Imperial College London, London, UK.
¹⁴ Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Ohio, USA; Department of General Anesthesiology, Emergency and Intensive Care Medicine, Medical University Graz, Austria.
¹⁵ Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Ohio, USA.
¹⁶ Department of Medicine, Unisinos University, São Leopoldo, Brazil; Department of Internal Medicine, Internal Medicine Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.

PMID: 38851520
DOI: 10.1016/j.ahj.2024.05.020

Abstract

Introduction: Troponin elevation after noncardiac surgery is associated with an elevated risk of 30-day mortality. Little is known about relative merit of using a high-sensitivity Troponin T (hsTnT), the fifth-generation assay, vs the nonhigh sensitivity Troponin T (non-hsTnT), the fourth-generation assay, in the noncardiac surgery setting. We aimed to identify whether hsTnT can identify additional patients at risk that would have gone undetected with non-hsTnT measurement.

Methods: The VISION Study included 40,004 noncardiac surgery patients with postoperative troponin measurements. Among them, 1,806 patients had both fourth-generation non-hsTnT and fifth-generation hsTnT concomitant measurements (4,451 paired results). We compared the absolute concentrations, the timing, and the impact of different thresholds on predicting 30-day major cardiovascular complications (composite of death, nonfatal cardiac arrest, coronary revascularization, and congestive heart failure).

Results: Based on the manufacturers' threshold of 14 ng/L, 580 (32.1%) patients had postoperative hsTnT concentrations greater than the threshold, while their non-hsTnT concentrations were below the manufacturer's threshold. These 580 patients had higher risk of major cardiovascular events (OR 2.33; CI 95% 1.04-5.23; P = .049) than patients with hsTnT concentrations below the manufacturer threshold. Among patients with myocardial injury after noncardiac surgery, only 50% would be detected by the fourth-generation non-hsTnT assay at 6 to 12 hours postoperative as compared to 85% with the fifth-generation hsTnT assay (P-value < .001).

Conclusions: Within the first 3 postoperative days, fifth-generation hsTnT identified at least 1 in 3 patients with troponin elevation that would have gone undetected by fourth-generation non-hsTnT using published thresholds in this setting. Furthermore, fifth-generation hsTnT identified patients with an elevation earlier than fourth-generation non-hsTnT, indicating potential to improve postoperative risk stratification.

Publication types

Comparative Study

MeSH terms

Aged
Biomarkers* / blood
Female
Humans
Male
Middle Aged
Postoperative Complications* / blood
Postoperative Complications* / epidemiology
Risk Assessment / methods
Surgical Procedures, Operative / adverse effects
Troponin T* / blood

Substances

Troponin T
Biomarkers