TY - JOUR
T1 - Postoperative troponin surveillance to detect myocardial infarction
T2 - an observational cohort modelling study
AU - Martinez-Perez, Selene
AU - van Waes, Judith A.R.
AU - Vernooij, Lisette M.
AU - Cuthbertson, Brian H.
AU - Beattie, W. Scott
AU - Wijeysundera, Duminda N.
AU - van Klei, Wilton A.
N1 - Publisher Copyright:
© 2023 British Journal of Anaesthesia
PY - 2024/4
Y1 - 2024/4
N2 - Background: Clinical presentation of postoperative myocardial infarction (POMI) is often silent. Several international guidelines recommend routine troponin surveillance in patients at risk. We compared how these different guidelines select patients for surveillance after noncardiac surgery with our established risk stratification model. Methods: We used outcome data from two prospective studies: Measurement of Exercise Tolerance before Surgery (METS) and Troponin Elevation After Major non-cardiac Surgery (TEAMS). We compared the major American, Canadian, and European guideline recommendations for troponin surveillance with our established risk stratification model. For each guideline and model, we quantified the number of patients requiring monitoring, % POMI detected, sensitivity, specificity, diagnostic odds ratio, and number needed to screen (NNS). Results: METS and TEAMS contributed 2350 patients, of whom 319 (14%) had myocardial injury, 61 (2.5%) developed POMI, and 14 (0.6%) died. Our risk stratification model selected fewer patients for troponin monitoring (20%), compared with the Canadian (78%) and European (79%) guidelines. The sensitivity to detect POMI was highest with the Canadian and European guidelines (0.85; 95% confidence interval [CI] 0.74–0.92). Specificity was highest using the American guidelines (0.91; 95% CI 0.90–0.92). Our risk stratification model had the best diagnostic odds ratio (2.5; 95% CI 1.4–4.2) and a lower NNS (21 vs 35) compared with the guidelines. Conclusions: Most postoperative myocardial infarctions were detected by the Canadian and European guidelines but at the cost of low specificity and a higher number of patients undergoing screening. Patient selection based on our risk stratification model was optimal.
AB - Background: Clinical presentation of postoperative myocardial infarction (POMI) is often silent. Several international guidelines recommend routine troponin surveillance in patients at risk. We compared how these different guidelines select patients for surveillance after noncardiac surgery with our established risk stratification model. Methods: We used outcome data from two prospective studies: Measurement of Exercise Tolerance before Surgery (METS) and Troponin Elevation After Major non-cardiac Surgery (TEAMS). We compared the major American, Canadian, and European guideline recommendations for troponin surveillance with our established risk stratification model. For each guideline and model, we quantified the number of patients requiring monitoring, % POMI detected, sensitivity, specificity, diagnostic odds ratio, and number needed to screen (NNS). Results: METS and TEAMS contributed 2350 patients, of whom 319 (14%) had myocardial injury, 61 (2.5%) developed POMI, and 14 (0.6%) died. Our risk stratification model selected fewer patients for troponin monitoring (20%), compared with the Canadian (78%) and European (79%) guidelines. The sensitivity to detect POMI was highest with the Canadian and European guidelines (0.85; 95% confidence interval [CI] 0.74–0.92). Specificity was highest using the American guidelines (0.91; 95% CI 0.90–0.92). Our risk stratification model had the best diagnostic odds ratio (2.5; 95% CI 1.4–4.2) and a lower NNS (21 vs 35) compared with the guidelines. Conclusions: Most postoperative myocardial infarctions were detected by the Canadian and European guidelines but at the cost of low specificity and a higher number of patients undergoing screening. Patient selection based on our risk stratification model was optimal.
KW - myocardial infarction
KW - myocardial injury
KW - noncardiac surgery
KW - postoperative
KW - surveillance
KW - troponin
UR - http://www.scopus.com/inward/record.url?scp=85184733163&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2023.12.019
DO - 10.1016/j.bja.2023.12.019
M3 - Article
C2 - 38233301
AN - SCOPUS:85184733163
SN - 0007-0912
VL - 132
SP - 667
EP - 674
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 4
ER -