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KMID : 0368120200500100925
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Korean Circulation Journal
2020 Volume.50 No. 10 p.925 ~ p.937
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Mildly Elevated Cardiac Troponin below the 99th-Percentile Upper Reference Limit after Noncardiac Surgery
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Park Jung-Chan
Hyeon Cheol-Won
Lee Seung-Hwa
Kim Ji-Hoon
Kwon Ji-Hye
Yang Kwang-Mo
Min Jeong-Jin
Lee Jong-Hwan
Lee Sang-Min
Yang Jeong-Hoon
Song Young-Bin
Hahn Joo-Yong
Choi Jin-Ho
Choi Seung-Hyuk
Kim Kyung-A
Ahn Joong-Hyun
Gwon Hyeon-Cheol
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Abstract
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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 score-matching, 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.
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KEYWORD
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Generalsurgery, Troponin, Mortality
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