PROGNOSTIC VALUE OF CARDIAC TROPONIN T AFTER NONCARDIAC SURGERY - 6-MONTH FOLLOW-UP DATA

Objectives. We sought to evaluate the prognostic significance of cardi ac troponin T (TnT) serum levels after noncardiac surgery. Background. Cardiac TnT has been found to be a marker for myocardial injury, but elevations of TnT are common in patients undergoing noncardiac surgery without clinical evidence of severe ischemia. Methods. We studied 772 patients who underwent major noncardiac procedures and did not have m ajor cardiovascular complications during their inpatient course. Total serum creatine kinase (CK) and cardiac TnT were measured according to a protocol that included sampling in the recovery room and during the next 2 days. A 6-month follow up interview was performed for 722 (94% ) of the patients. Results. Elevated cardiac TnT and CK-MB results wer e detected for 92 (12%) and 211 (27%) patients, respectively. During t he follow-up period, there were 19 (2.5%) major cardiac complications, including 14 cardiac deaths, 3 nonfatal myocardial in farctions and 2 admissions for unstable angina. Compared with patients with cardiac T nT values <0.1 ng/ml, patients with elevated TnT had a relative risk f or cardiac events of 5.4 (95% confidence interval: 2.2 to 13, p = 0.00 1), whereas CK-MB was not correlated with postdischarge cardiac events . In multivariate logistic regression analysis adjusting for preoperat ive clinical and CK-MB data, a cardiac TnT value >0.1 ng/ml was an ind ependent correlate of cardiac events (adjusted odds ratio 4.6, p < 0.0 5). This correlation was a function of the relation of elevated TnT le vels with postoperative in-hospital congestive heart failure and new s ustained arrhythmias, suggesting that elevated postoperative TnT level s detected myocardial ischemia during these clinical events. Conclusio ns. We conclude that an abnormal TnT level in patients undergoing nonc ardiac surgery may be a useful marker of ischemic disease and a predic tor of 6-month prognosis. (C) 1997 by the American College of Cardiolo gy.