Troponin T Blood Levels Identify Risk of Death Following Surgery

A simple blood test can help identify people who are at high risk of dying within the month after noncardiac surgery.

The blood test for the level of troponin T can help physicians target patients who need enhanced observation or interventions. Currently, troponin levels are not commonly measured after surgery.

The results are from the VISION study, the largest international prospective study evaluating complications after surgery. VISION enrolled 15,133 adult patients in North and South America, Asia, Australia, and Europe who had a Troponin T measurement daily during the first three days after surgery. Patients were followed in hospital at 30 days after surgery.

"VISION demonstrated that a simple blood test strongly identifies which noncardiac surgery patients are at high risk of dying in the next 30 days," said Dr. P.J. Devereaux, VISION principal investigator; associate professor of medicine, clinical epidemiology and biostatistics of the Michael G. DeGroote School of Medicine at McMaster University (Hamilton, ON, Canada) and cardiologist at Hamilton Health Sciences (Hamilton, ON, Canada).

Devereaux said the results also demonstrated that most patients did not die until an average of six or more days after their Troponin T blood test was identified as elevated. "This holds out great hope that there is time to intervene."

Currently many laboratories consider a Troponin T measurement >0.04 ng/mL abnormal. VISION demonstrated that Troponin T (TnT) values below the commonly used threshold of 0.04 (i.e., 0.02 and 0.03) were strongly associated with 30-day mortality.

More than 200 million adults worldwide have major noncardiac surgery each year. Despite the benefits of surgery, many patients suffer serious complications and more than one million of those patients die within the first 30 days after surgery. Surgery activates pathways of inflammation, stress, and clotting that predispose the heart to injury. As a result, many patients suffer heart attacks after surgery.

The study was published in the June 2012 Journal of the American Medical Association(JAMA).

Related Links:
Michael G. DeGroote School of Medicine at McMaster University
Hamilton Health Sciences