Postcardiac surgery high-sensitivity troponin levels greater than 200 times the upper limit of normal are associated with greater mortality

Reference

Deveraux PJ, Lamy A, Chan MTV et al. High-sensitivity troponin I after cardiac surgery and 30-day mortality. N Engl J Med 2022;386(9):827-836.

Synopsis

There is a lack of consensus regarding the threshold level of high-sensitivity troponin I that defines clinically important periprocedural myocardial injury for patients undergoing cardiac surgery. The current recommended threshold level ranges from greater than 10 times to greater than or equal to 70 times the upper limit of normal (ULN), according to various guidelines. In this multicenter international study, investigators analyzed data from almost 14,000 adult patients who were undergoing cardiac surgery. Patients had a mean age of 63 years, 71% were men, and 30% had a previous history of myocardial infarction. Sixty percent of the cohort underwent coronary artery bypass grafting (CABG) or aortic valve replacement (AVR). High-sensitivity troponin levels were obtained 3 to 12 hours after surgery, as well as on postoperative days 1, 2, and 3. The primary outcome was death within 30 days after surgery. Overall, 2% of patients died and 3% had major vascular complications within those 30 days. During the first day after surgery, 98% of the patients who had troponin measured had a peak level of greater than 10 times the ULN and 75% had a level at least 70 times the ULN. For patients who underwent CABG or AVR, the lowest troponin value measured within 1 day of surgery that was associated with an adjusted hazard ratio of greater than 1 for 30-day mortality was 5670 ng/L, a value that is 218 times the ULN. Similarly, for the outcome of major vascular complications at 30 days, the threshold level was 4184 ng/L, or 161 times the ULN.