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

Borges FK 1 , Sessler DI 2 , Tiboni M 3 , Patel A 3 , LeManach Y 4 , Heels-Ansdell D 5 Show all authors , Srinathan S 6 , Wang CY 7 , Chow C 8 , Duceppe E 9 , Kavsak P 10 , Ofori SN 11 , Pettit S 12 , Berwanger O 13 , Kurz A 14 , Turan A 15 , Tonelli AC 16 , Devereaux PJ 4 , 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: Flavia.borges@phri.ca
  • 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
Am Heart J, 2024 Sep;275:45-52.
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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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