Incidence and outcomes of perioperative myocardial infarction/injury diagnosed by high-sensitivity cardiac troponin I

Background Perioperative myocardial infarction/injury (PMI) diagnosed by high-sensitivity troponin (hs-cTn) T is frequent and a prognostically important complication of non-cardiac surgery. We aimed to evaluate the incidence and outcome of PMI diagnosed using hs-cTnI, and compare it to PMI diagnosed using hs-cTnT. Methods We prospectively included 2455 patients at high cardiovascular risk undergoing 3111 non-cardiac surgeries, for whom hs-cTnI and hs-cTnT concentrations were measured before surgery and on postoperative days 1 and 2. PMI was defined as a composite of perioperative myocardial infarction (PMIInfarct) and perioperative myocardial injury (PMIInjury), according to the Fourth Universal Definition of Myocardial Infarction. All-cause mortality was the primary endpoint. Results Using hs-cTnI, the incidence of overall PMI was 9% (95% confidence interval [CI] 8–10%), including PMIInfarct 2.6% (95% CI 2.0–3.2) and PMIInjury 6.1% (95% CI 5.3–6.9%), which was lower versus using hs-cTnT: overall PMI 15% (95% CI 14–16%), PMIInfarct 3.7% (95% CI 3.0–4.4) and PMIInjury 11.3% (95% CI 10.2–12.4%). All-cause mortality occurred in 52 (2%) patients within 30 days and 217 (9%) within 1 year. Using hs-cTnI, both PMIInfarct and PMIInjury were independent predictors of 30-day all-cause mortality (adjusted hazard ratio [aHR] 2.5 [95% CI 1.1–6.0], and aHR 2.8 [95% CI 1.4–5.5], respectively) and, 1-year all-cause mortality (aHR 2.0 [95% CI 1.2–3.3], and aHR 1.8 [95% CI 1.2–2.7], respectively). Overall, the prognostic impact of PMI diagnosed by hs-cTnI was comparable to the prognostic impact of PMI using hs-cTnT. Conclusions Using hs-cTnI, PMI is less common versus using hs-cTnT. Using hs-cTnI, both PMIInfarct and PMIInjury remain independent predictors of 30-day and 1-year mortality. Graphic abstract Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01827-w.

Supplemental Tables eTable 1. STROBE Statement-Checklist of items that should be included in reports of cohort studies.

Item No Recommendation
Page Title and Abstract 1 (a) Indicate the study's design with a commonly used term in the title or the abstract.

Introduction
Background/rationale 2 Explain the scientific background and rationale for the investigation being reported.

5
Objectives 3 State specific objectives, including any prespecified hypotheses.

Study design 4
Present key elements of study design early in the paper. 7 Setting 5 Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection.

7-9
Participants 6 (a) Give the eligibility criteria, and the sources and methods of selection of participants. Describe methods of follow-up.

7,9
(b)For matched studies, give matching criteria and number of exposed and unexposed. - Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic criteria, if applicable.

7-10 Supplement
Data sources/measurement 8* For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe comparability of assessment methods if there is more than one group.

7-9 Supplement
Bias 9 Describe any efforts to address potential sources of bias. 9-10 Study size 10 Explain how the study size was arrived at. 7-10 Quantitative variables

11
Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why.

8-10
Statistical methods 12 (a) Describe all statistical methods, including those used to control for confounding.

9-10
(b) Describe any methods used to examine subgroups and interactions.

10
(c) Explain how missing data were addressed. 10 (d) If applicable, explain how loss to follow-up was addressed. 9 (e) Describe any sensitivity analyses. 10

Results
Participants 13* (a) Report numbers of individuals at each stage of study-e.g. numbers potentially eligible, examined for eligibility, confirmed eligible, included in the study, completing follow-up, and analyzed.