Document Detail

Intermittent cardiac troponin-I screening is an effective means of surveillance for a perioperative myocardial infarction.
MedLine Citation:
PMID:  16202889     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Several studies suggest that cardiac troponin-I (cTn-I) is a more sensitive indicator of cardiac injury compared with other biochemical markers of injury, but the strategy with the highest diagnostic yield (true positive and true negative) for perioperative surveillance is unknown. The authors undertook a prospective evaluation of the perioperative incidence of myocardial infarction (MI) and evaluated surveillance strategies for the diagnosis of MI. DESIGN: Prospective, cohort study. SETTING: Two university hospitals. PARTICIPANTS: Four hundred sixty-seven high-risk patients requiring noncardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The diagnosis of myocardial injury was determined by cardiac protein markers combined with either postoperative changes on 12-lead electrocardiography or 1 of 3 clinical symptoms consistent with MI (chest pain, dyspnea, requirement for hemodynamic support). A receiver operating characteristic curve evaluating troponin in the diagnosis of MI revealed a value of 2.6 ng/mL as having the highest sensitivity and specificity. The sensitivity and specificity of cTn-I value > or =2.6 ng/mL, troponin > or =1.5 ng/mL, total creatine kinase (CK) > or =170 IU/L with MB > or =5%, and CK-MB > or =8 ng/mL were compared. Surveillance strategies were determined on a subset of patients (n = 257). The incidence of MI was 9.0% by cTn-I > or =2.6 ng/mL criteria, 19% by cTn-I > or =1.5 ng/mL, 13% by CK-MB mass, and 2.8% by CK-MB%. The specificity of cTn-I > or =2.6 ng/mL as an indicator of MI was 98%, and its positive predictive value (PPV) was 85%. Cardiac troponin-I > or =2.6 ng/mL had equal specificity but greater PPV than the cTn-I > or =1.5 ng/mL (specificity 98% and PPV 79%). If surveillance of cTn-I > or =2.6 ng/mL was used to detect MI, then the strategy with the highest diagnostic yield was surveillance on postoperative days 1, 2, and 3. CONCLUSIONS: Perioperative cardiac injury continues to occur frequently after noncardiac surgery, as detected by cTn-I. Serial monitoring of cardiac troponin-I on postoperative days 1, 2, and 3 provides the strategy with the highest diagnostic yield for surveillance of MI.
Elizabeth A Martinez; Caitlin M Nass; Roland M Jermyn; Stanley H Rosenbaum; Shamsuddin Akhtar; Daniel W Chan; Herbert Malkus; James L Weiss; Lee A Fleisher
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  19     ISSN:  1053-0770     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-05     Completed Date:  2006-02-28     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  577-82     Citation Subset:  IM    
The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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MeSH Terms
Biological Markers / blood
Creatine Kinase, MB Form / blood
Middle Aged
Monitoring, Physiologic / methods*,  statistics & numerical data
Myocardial Infarction / blood,  diagnosis*
Postoperative Complications / blood,  diagnosis*,  etiology
Postoperative Period
Predictive Value of Tests
Prospective Studies
Time Factors
Treatment Outcome
Troponin I / blood*
Vascular Diseases / surgery
Grant Support
Reg. No./Substance:
0/Biological Markers; 0/Troponin I; EC Kinase, MB Form

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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