Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery

Study Questions:

Do troponin levels predict risk of death at 30 days after noncardiac surgery?

Methods:

The data used for the present analysis were from the VISION study, a prospective cohort study of a representative sample of patients undergoing noncardiac surgery. Patients, ages 45 years or older, were enrolled from North and South America, Africa, Asia, Australia, and Europe between August 2007, and January 2011. All participants were required to have an overnight admission following noncardiac surgery, received general or regional anesthetic, and had undergone elective, urgent, or emergency surgery. Troponin levels were measured 6-12 hours after surgery and on postoperative days 1, 2, and 3. The primary outcome of interest was mortality at 30 days.

Results:

A total of 15,133 patients were included in this study. The 30-day mortality rate was 1.9% (95% confidence interval [CI], 1.7%-2.1%). A peak troponin of 0.02 ng/ml or greater occurred in 11.6% of patients, and was associated with an increased 30-day mortality compared with the reference group (troponins ≤0.01 ng/ml). After adjustment for multiple factors, troponin levels were associated with 30-day mortality in a dose-dependent fashion; hazard ratio [HR] was 2.41 (95% CI, 1.33-3.77) for troponin levels of 0.02 ng/dl (mortality rate 4%); HR was 5.00 (95% CI, 3.72-6.76) for troponin levels between 0.03 and 0.29 ng/ml (mortality rate 9.3%); and the HR was 10.48 (95% CI, 6.25-16.62) for troponin levels of 0.3 ng/ml or greater (mortality rate 16.9%). Peak troponin measurement added incremental prognostic value to discriminate those most likely to die within 30 days of surgery; net reclassification was 25% (p < 0.001).

Conclusions:

The investigators concluded that among patients undergoing noncardiac surgery, peak troponin in the first three postoperative days is a significant predictor of 30-day mortality.

Perspective:

These data suggest that troponins may assist in identifying high-risk patients undergoing noncardiac surgeries. Looking at characteristics associated with higher-risk patients may allow for improvements in perioperative management, resulting in lower mortality rates.

Keywords: South America, Risk Factors, Europe, Azepines, Surgical Procedures, Elective, Perioperative Care, Biological Markers, Troponin I, Cardiology, Australia, Confidence Intervals


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