Mildly Elevated Cardiac Troponin below the 99th-Percentile Upper Reference Limit after Noncardiac Surgery
- Author:
Jungchan PARK
1
;
Cheol Won HYEON
;
Seung-Hwa LEE
;
Jihoon KIM
;
Ji-Hye KWON
;
Kwangmo YANG
;
Jeong Jin MIN
;
Jong Hwan LEE
;
Sangmin Maria LEE
;
Jeong Hoon YANG
;
Young Bin SONG
;
Joo-Yong HAHN
;
Jin-ho CHOI
;
Seung-Hyuk CHOI
;
Kyunga KIM
;
Joonghyun AHN
;
Hyeon-Cheol GWON
Author Information
- Publication Type:Original Article
- From:Korean Circulation Journal 2020;50(10):925-937
- CountryRepublic of Korea
-
Abstract:
Background and Objectives:In patients with perioperative cardiac troponin (cTn) I below the 99th-percentile upper range of limit (URL), mortality according to cTn I level has not been fully evaluated. This study evaluated the association between postoperative cTn I level above the lowest limit of detection but within the 99th-percentile URL and 30-day mortality after noncardiac surgery.
Methods:Patients with cTn I values below the 99th-percentile URL during the perioperative period were divided into a no-elevation group with cTn I at the lowest limit of detection (6 ng/L) and a minor elevation group with cTn I elevation below the 99th percentile URL (6 ng/L < cTn I < 40 ng/L). The primary outcome was 30-day mortality.
Results:Of the 5,312 study participants, 2,582 (48.6%) were included in the no-elevation group and 2,730 (51.4%) were included in the minor elevation group. After propensity scorematching, the minor elevation group showed significantly increased 30-day mortality (0.5% vs. 2.3%; hazard ratio, 4.30; 95% confidence interval, 2.23–8.29; p<0.001). The estimated cutoff value of cTn I to predict 30-day mortality was 6 ng/L with the area under the receiver operating characteristic curve 0.657.
Conclusions:A mild elevation of cTn I within the 99th-percentile URL after noncardiac surgery was significantly associated with increased 30-day mortality as compared with the lowest limit of detection.
