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Mildly Elevated Cardiac Troponin below the 99th-Percentile Upper Reference Limit after Noncardiac Surgery

Korean Circulation Journal 2020년 50권 10호 p.925 ~ 937
박정찬, 현철원, 이승화, 김지훈, 권지혜, 양광모, 민정진, 이종환, 이상민, 양정훈, 송영빈, 한주용, 최진호, 최승혁, 김경아, 안중현, 권현철,
소속 상세정보
박정찬 ( Park Jung-Chan ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
현철원 ( Hyeon Cheol-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
이승화 ( Lee Seung-Hwa ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
김지훈 ( Kim Ji-Hoon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
권지혜 ( Kwon Ji-Hye ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
양광모 ( Yang Kwang-Mo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Center for Health Promotion
민정진 ( Min Jeong-Jin ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
이종환 ( Lee Jong-Hwan ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
이상민 ( Lee Sang-Min ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
양정훈 ( Yang Jeong-Hoon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
송영빈 ( Song Young-Bin ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
한주용 ( Hahn Joo-Yong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
최진호 ( Choi Jin-Ho ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
최승혁 ( Choi Seung-Hyuk ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
김경아 ( Kim Kyung-A ) - Samsung Medical Center Research Institute for Future Medicine Statistics and Data Center
안중현 ( Ahn Joong-Hyun ) - Samsung Medical Center Research Institute for Future Medicine Statistics and Data Center
권현철 ( Gwon Hyeon-Cheol ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine

Abstract


Background and Objectives: In patients with perioperative cardiac troponin (cTn) I below the 99th-percentile upper range of limit (URL), mortality according to cTn I level has not been fully evaluated. This study evaluated the association between postoperative cTn I level above the lowest limit of detection but within the 99th-percentile URL and 30-day mortality after noncardiac surgery.

Methods: Patients with cTn I values below the 99th-percentile URL during the perioperative period were divided into a no-elevation group with cTn I at the lowest limit of detection (6 ng/L) and a minor elevation group with cTn I elevation below the 99th percentile URL (6 ng/L < cTn I < 40 ng/L). The primary outcome was 30-day mortality.

Results: Of the 5,312 study participants, 2,582 (48.6%) were included in the no-elevation group and 2,730 (51.4%) were included in the minor elevation group. After propensity score-matching, the minor elevation group showed significantly increased 30-day mortality (0.5% vs. 2.3%; hazard ratio, 4.30; 95% confidence interval, 2.23?8.29; p<0.001). The estimated cutoff value of cTn I to predict 30-day mortality was 6 ng/L with the area under the receiver operating characteristic curve 0.657.

Conclusions: A mild elevation of cTn I within the 99th-percentile URL after noncardiac surgery was significantly associated with increased 30-day mortality as compared with the lowest limit of detection.

키워드

Generalsurgery; Troponin; Mortality

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