High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality. / the VISION Cardiac Surgery Investigators.
In: New England Journal of Medicine, Vol. 386, No. 9, 03.03.2022, p. 827-836.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality
AU - the VISION Cardiac Surgery Investigators
AU - Devereaux, P. J.
AU - Lamy, Andre
AU - Chan, Matthew T.V.
AU - Allard, René V.
AU - Lomivorotov, Vladimir V.
AU - Landoni, Giovanni
AU - Zheng, Hong
AU - Paparella, Domenico
AU - McGillion, Michael H.
AU - Belley-Côté, Emilie P.
AU - Parlow, Joel L.
AU - Underwood, Malcolm J.
AU - Wang, Chew Yin
AU - Dvirnik, Nazari
AU - Abubakirov, Marat
AU - Fominskiy, Evgeny
AU - Choi, Stephen
AU - Fremes, Stephen
AU - Monaco, Fabrizio
AU - Urrútia, Gerard
AU - Maestre, Marialuz
AU - Hajjar, Ludhmila A.
AU - Hillis, Graham S.
AU - Mills, Nicholas L.
AU - Margari, Vito
AU - Mills, Joseph D.
AU - Billing, J. Stephen
AU - Methangkool, Emily
AU - Polanczyk, Carisi A.
AU - Sant'Anna, Roberto
AU - Shukevich, Dmitry
AU - Conen, David
AU - Kavsak, Peter A.
AU - McQueen, Matthew J.
AU - Brady, Katheryn
AU - Spence, Jessica
AU - Le Manach, Yannick
AU - Mian, Rajibul
AU - Lee, Shun Fu
AU - Bangdiwala, Shrikant I.
AU - Hussain, Sara
AU - Borges, Flavia K.
AU - Pettit, Shirley
AU - Vincent, Jessica
AU - Guyatt, Gordon H.
AU - Yusuf, Salim
AU - Alpert, Joseph S.
AU - White, Harvey D.
AU - Whitlock, Richard P.
N1 - Funding Information: Supported by an operating grant from the Canadian Institutes of Health Research , the Canadian Institutes of Health Research Foundation , the Canadian Institutes of Health Research Strategy for Patient Oriented Research (through the Ontario SPOR Support Unit, and the Ontario Ministry of Health and Long-Term Care), and Abbott Laboratories (grants and in-kind donation of high-sensitivity cardiac troponin I assays used in this study); in Canada, grants from the Hamilton Health Sciences New Investigator Fund , the Canadian Network and Centre for Trials Internationally , the Hamilton Health Sciences Research Strategic Initiative , McMaster University Surgical Associates , the Academic Health Science Centres Alternative Funding Plan Innovation Fund Ontario, and the Population Health Research Institute Internal Funding Program ; in China, a grant from the General Research Fund 14101414, Research Grant Council, Hong Kong Special Administrative Region ; in Malaysia, a University of Malaya research grant (RG302-14AFR); in Australia, the National Heart Foundation of Australia Vanguard Grant (101034) and a grant from the National Health and Medical Research Program ; in the United Kingdom, the British Heart Foundation Personal Chair grant (CH/F/21/90010) and Research Excellence grant (RE/18/5/34216); and in Spain, a grant from the Instituto de Salud Carlos III (PI13/00502). Publisher Copyright: Copyright © 2022 Massachusetts Medical Society.
PY - 2022/3/3
Y1 - 2022/3/3
N2 - BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.
AB - BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.
KW - Aged
KW - Aortic Valve/surgery
KW - Biomarkers/blood
KW - Cardiac Surgical Procedures/adverse effects
KW - Coronary Artery Bypass/adverse effects
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Postoperative Complications/blood
KW - Prospective Studies
KW - Reference Values
KW - Troponin I/blood
UR - http://www.scopus.com/inward/record.url?scp=85126116030&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/12bd2e36-cf3e-367d-b0fd-e28cd22a8e76/
U2 - 10.1056/NEJMoa2000803
DO - 10.1056/NEJMoa2000803
M3 - Article
C2 - 35235725
AN - SCOPUS:85126116030
VL - 386
SP - 827
EP - 836
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 9
ER -
ID: 35689547