Clinical use of ultrasensitive cardiac troponin I assay in intermediate- and high-risk surgery patients

• Autor(a) principal: Borges, Flávia Kessler
• Data de Publicação: 2013
• Outros Autores: Furtado, Mariana Vargas, Rossini, Ana Paula Webber, Bertoluci, Carolina, Gonzalez, Vinícius Leite, Bertoldi, Eduardo Gehling, Pezzali, Luíza Guazzelli, Machado, Daniel Luft, Grutcki, Denis Maltz, Rech, Leandro Gazziero, Magalhães, Mariana, Polanczyk, Carisi Anne
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFRGS
• Texto Completo: http://hdl.handle.net/10183/166261
• topic: Infarto do miocárdio; Estimativa de Kaplan-Meier; Período pós-operatório; Seleção de pacientes; Troponina I; Resultado do tratamento; Curva ROC

Background. Cardiac troponin levels have been reported to add value in the detection of cardiovascular complications in noncardiac surgery. A sensitive cardiac troponin I (cTnI) assay could provide more accurate prognostic information. Methods. This study prospectively enrolled 142 patients with at least one Revised Cardiac Risk Index risk factor who underwent noncardiac surgery. cTnI levels were measured postoperatively. Short-term cardiac outcome predictors were evaluated. Results. cTnI elevation was observed in 47 patients, among whom 14 were diagnosed as having myocardial infarction (MI). After 30 days, 16 patients had major adverse cardiac events (MACE). Excluding patients with a final diagnosis of MI, predictors of cTnI elevation included dialysis, history of heart failure, transoperativemajor bleeding, and elevated levels of pre- and postoperativeN-terminal pro-B-type natriuretic peptide (NT-proBNP). Maximal cTnI values showed the highest sensitivity (94%), specificity (75%), and overall accuracy (AUC 0.89; 95% CI 0.80–0.98) for postoperative MACE. Postoperative cTnI peak level (OR 9.4; 95% CI 2.3–39.2) and a preoperative NT-proBNP level ≥917 pg/mL (OR 3.47; 95% CI 1.05–11.6) were independent risk factors for MACE. Conclusions. cTnI was shown to be an independent prognostic factor for cardiac outcomes and should be considered as a component of perioperative risk assessment.