%0 Journal Article
%T Clinical Use of Ultrasensitive Cardiac Troponin I Assay in Intermediate- and High-Risk Surgery Patients
%A Fl芍via Kessler Borges
%A Mariana Vargas Furtado
%A Ana Paula Webber Rossini
%A Carolina Bertoluci
%A Vin赤cius Leite Gonzalez
%A Eduardo Gehling Bertoldi
%A Lu赤za Guazzeli Pezzali
%A Daniel Luft Machado
%A Denis Maltz Grutcki
%A Leandro Gazziero Rech
%A Mariana Magalhˋes
%A Carisi Anne Polanczyk
%J Disease Markers
%D 2013
%R 10.1155/2013/169356
%X Background. Cardiac troponin levels have been reported to add value in the detection of cardiovascular complications in noncardiac surgery. A sensitive cardiac troponin I (cTnI) assay could provide more accurate prognostic information. Methods. This study prospectively enrolled 142 patients with at least one Revised Cardiac Risk Index risk factor who underwent noncardiac surgery. cTnI levels were measured postoperatively. Short-term cardiac outcome predictors were evaluated. Results. cTnI elevation was observed in 47 patients, among whom 14 were diagnosed as having myocardial infarction (MI). After 30 days, 16 patients had major adverse cardiac events (MACE). Excluding patients with a final diagnosis of MI, predictors of cTnI elevation included dialysis, history of heart failure, transoperative major bleeding, and elevated levels of pre- and postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP). Maximal cTnI values showed the highest sensitivity (94%), specificity (75%), and overall accuracy (AUC 0.89; 95% CI 0.80每0.98) for postoperative MACE. Postoperative cTnI peak level (OR 9.4; 95% CI 2.3每39.2) and a preoperative NT-proBNP level ≡917ˋpg/mL (OR 3.47; 95% CI 1.05每11.6) were independent risk factors for MACE. Conclusions. cTnI was shown to be an independent prognostic factor for cardiac outcomes and should be considered as a component of perioperative risk assessment. 1. Introduction In recent years, many high-risk patients have undergone major noncardiac surgeries and have suffered adverse cardiac events. Perioperative myocardial ischemia occurs in up to 40% of patients at risk of coronary artery disease, but it is usually clinically silent and therefore difficult to detect [1每3]. More importantly, it is a major factor related to long-term adverse events generally occurring in 5.6% of high-risk coronary artery disease patients [4, 5]. Several preoperative risk stratification scores have been developed and adjusted over recent years [4, 6每8]. Nonetheless, the prognostic accuracy of these scores is limited, given that only patient history and preoperative clinical status are considered to predict short-term morbidity and mortality or to identify patients in need of more detailed cardiac testing. Patient outcomes do not only depend on preoperative findings or the type of surgery performed but also on perioperative events. Troponin elevation in the perioperative period has been reported to provide added diagnostic value to the detection of cardiovascular complications [9每18]. Several studies have demonstrated that monitoring cardiac enzymes
%U http://www.hindawi.com/journals/dm/2013/169356/