• Michael Weber, Andreas Luchner, Manfred Seeberger, Seeberger Manfred, Christian Mueller, Christoph Liebetrau, Axel Schlitt, Svetlana Apostolovic, Radmilo Jankovic, Dragic Bankovic, Marina Jovic, Veselin Mitrovic, Holger Nef, Helge Mollmann, and Christian W Hamm.
• Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. m.weber@kreiskliniken-dadi.de
• Eur. Heart J. 2013 Mar 1;34(11):853-62.

AimsWe aimed to evaluate the incremental value of high-sensitive troponin T (hsTnT) for risk prediction prior to non-cardiac surgery in comparison with the established revised cardiac index.Methods And ResultsIn this prospective, international multicentre observational study, 979 patients prior to non-cardiac surgery were enrolled. The endpoints were in-hospital mortality, the combination of death, acute myocardial infarction, cardiac arrest, cardio-pulmonary resuscitation, and acute decompensated heart failure. Twenty-five patients (2.6%) deceased and 36 (3.7%) of the patients experienced the combined endpoint. Cardiac markers were elevated in those patients who died when compared with survivors (hsTnT: 21 ng/L vs. 7 ng/L; P < 0.001; NT-proBNP: 576 pg/mL vs. 166 pg/mL; P < 0.001). Applying a cut-off for hsTnT of 14 ng/L and for NT-proBNP of 300 pg/mL, those patients with elevated hsTnT had a mortality of 6.9 vs. 1.2% (P < 0.001) and with elevated NT-proBNP 4.8 vs. 1.4% (P = 0.002). The highest AUC of the ROC curve was found for hsTnT as a predictor for mortality of 0.809. In a multivariate Cox regression analyses, hsTnT was the strongest independent predictor for the combined endpoint [HR 2.6 (95% CI: 1.3-5.3); P = 0.01].ConclusionHigh-sensitive troponin T provides strong prognostic information in patients undergoing non-cardiac surgery incremental to the widely accepted revised cardiac index.

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