Elevated Biomarker Following Surgery Linked to Increased Risk of Death

Among patients undergoing noncardiac surgery, peak postoperative high-sensitivity troponin T measurements (proteins that are released when the heart muscle has been damaged) during the first three days after surgery were associated with an increased risk of death at 30 days, according to a study published by JAMA.
 
Large observational studies suggest that among patients 45 years or older undergoing major noncardiac surgery, more than 1 percent die in hospital or within 30 days of surgery. Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial (the muscular tissue of the heart) injury after noncardiac surgery (MINS). P.J. Devereaux, M.D., Ph.D., of McMaster University, Hamilton, Ontario, Canada, and colleagues conducted a study that included patients 45 years or older who underwent inpatient noncardiac surgery and had postoperative hsTnT measurements six to 12 hours after surgery and daily for three days. The patients were recruited at 23 centers in 13 countries.
 
Among 21,842 participants, the average age was 63 years and 49 percent were female. Death within 30 days after surgery occurred in 266 patients. Analysis indicated that compared with the reference group (peak hsTnT <5 ng/L), peak postoperative hsTnT levels of 20 to less than 65 ng/L had 30-day mortality rates of 3 percent; 65 to less than 1,000 ng/L, a mortality rate of 9.1 percent; and patients with peak postoperative hsTnT levels of 1,000 ng/L or higher had 30-day mortality rates of 29.6 percent.
 
An absolute hsTnT change of 5 ng/L or higher was associated with an increased risk of 30-day mortality. An elevated postoperative hsTnT without an ischemic feature (e.g., ischemic symptom or electrocardiography finding) was associated with 30-day mortality.
 
(doi:10.1001/jama.2017.4360)