ISSN: 0034-8376
eISSN: 2564-8896






Evaluation of Perioperative High-Sensitive Cardiac Troponin I as a Predictive Biomarker of Major Adverse Cardiovascular Events After Noncardiac Surgery



Alejandro Millán-Figueroa, Departments of Internal Medicine, Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico City, Mexico
Juan M. López-Navarro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Mexico City, México
Iván Pérez-Díaz, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tecnológico de Monterrey. Mexico City, México
Jaime Galindo-Uribe, Department of Cardiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico
Blanca García-Martínez, Departments of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico
Sonia L. Del Villar-Velasco, Central Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico
Tomás López-Gómez, Central Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico
Zamar Zavaleta- Martínez, Department of Cardiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico
Eduardo J. Valladares-Pérez, Departments of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico
Hillary K. Osorio-Landa, Departments of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico
Andrea G. Nieto-Niño, Department of Cardiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico
Rodrigo F. Fernández-Pellón García, Department of Cardiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico
Reynerio Fagundo-Sierra, Central Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, SSA, Mexico City, Mexico


Background: Various studies suggest that perioperative concentrations of high-sensitivity troponins are incremental and predictive factors of a major adverse cardiac event (MACE) and all-cause mortality. Objective: The objective of the study was to evaluate the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) in the development of MACE and all-cause mortality, within 30-days and 1-year follow-up after noncardiac surgery. Methods: In this prospective cohort study, we included men ≥ 45 years and women ≥ 55 years with ≥ 2 cardiovascular risk factors and undergoing intermediate or high-risk noncardiac surgery. Demographic and clinical information was collected from clinical charts. We measured baseline hs-cTnI 24 h before surgery, and its post-operative concentration 24 h after surgery. Results: In the entire sample, 8 patients (8.6%) developed MACE at 30-days follow-up (4 deaths), 12 (12.9%) within the 1st year (7 deaths), and 17 (18.2%) after complete post-surgical follow-up (10 deaths). We observed higher baseline and post-operative concentrations in patients who presented MACE (12 pg/ml vs. 3.5 pg/ml; p = 0.001 and 18.3 pg/ml vs. 5.45 pg/ml; p = 0.009, respectively). The hazard ratios (HRs) calculated by Cox regression analysis between the hs-cTnI baseline concentration and the post-operative development of MACE at 30-days and 1-year were 5.70 (95% confidence interval [CI], 1.10-29.40) with hs-cTnI > 6.2 pg/ml and 12.86 (95% CI, 1.42-116.34) with hs-cTnI > 3.3 pg/ml, respectively. The estimated post-operative HR death risk at 1-year was 14.43 (95% CI, 1.37-151.61) with hs-cTnI > 4.5 pg/ml. Conclusions: Pre-operative hs-cTnI was an independent predictive risk factor for MACE at 30-days and 1-year after noncardiac surgery and for all-cause mortality at 1-year after noncardiac surgery.



Keywords: Cardiac troponins. Noncardiac surgery. Major adverse cardiac event. Mortality.