Evidence map›Paper›PMID 28444280›Full record

ArticleJAMA2017

Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery.

Writing Committee for the VISION Study Investigators, P J Devereaux, Bruce M Biccard, Alben Sigamani, Denis Xavier, Matthew T V Chan, Sadeesh K Srinathan, Michael Walsh, Valsa Abraham, Rupert Pearse and 44 more

17 registry-linked trialsOpen access · greenAbstract read
PubMed Publisher
In one paragraph

Article in JAMA, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 17 registered trials, which are not on this map. Cited by 325 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
325citing papers in PubMed, 7 pooled it
55.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03375476 completednot on this mapstarted 2018, after this paper: background citation

Evaluation of a Model for Post-anesthesia Troponin Increase and Heart Injury Estimation

TypeobservationalSponsorASST Fatebenefratelli SaccoRan2018 to 2019Enrolled117ConditionsPostoperative Myocardial IschemiaArmscollection of cardiovascular risk scores and intraoperative cardiovascular parameters, cardiac troponin assay, Electrocardiogram
NCT03418194 nacompletednot on this mapstarted 2018, after this paper: background citation

Effects of Transcutaneous Acupoint Electrical Stimulation on Postoperative Heart Rate Variability and High-sensitive Cardiac Troponin of Elderly Patients With Coronary Heart Disease

TypeinterventionalSponsorHebei Medical University Third HospitalRan2018 to 2018Enrolled137ConditionsCoronary Artery Disease, AnesthesiaArmstranscutaneous acupoint electrical stimulation, sham transcutaneous acupoint electrical stimulation
NCT03765372 completednot on this map

Evaluation of hsTnT for Perioperative Risk Stratification Among Patients Undergoing Elective Non-cardiac Surgery

Typeobservational_patient_registrySponsorTechnical University of MunichRan2017 to 2021Enrolled1,598ConditionsPerioperative/Postoperative Complications, Outcome
NCT04077294 completednot on this mapstarted 2019, after this paper: background citation

Epidemiological Patterns, Management Strategies and Cost Analysis of Care for the Patient With Perioperative Myocardial Injury When BNP is Used as a Screening Tool for Non-Cardiac Surgery

TypeobservationalSponsorUniversity of AlbertaRan2019 to 2019Enrolled333ConditionsMyocardial Infarction Postoperative, Myocardial Injury, Death, CardiacArmsCardiac risk stratification using preoperative BNP measurement, followed by postoperative cardiac monitoring, Use of traditional perioperative cardiac risk stratification only
NCT04187664 naunknown statusnot on this mapstarted 2019, after this paper: background citation

Implementation of the Extended Care in High-Risk Surgical Patient (EXCARE) Pathway in High-risk Non-cardiac Surgical Population: Impact on Morbidity and 30-day Mortality

TypeinterventionalSponsorHospital de Clinicas de Porto AlegreRan2019 to 2021Enrolled1,720ConditionsPostoperative Complications, Patient Care TeamArmsPostoperative Monitoring, High-sensitivity cardiac troponin testing
NCT04329624 phase3completednot on this mapstarted 2020, after this paper: background citation

The Effect of Perioperative LevosIMendan Administration on Postoperative N-terminal pRo Brain Natriuretic Peptide Concentration in Patients With Increased cardiOVascular Risk Factors Undergoing Noncardiac surgEry - A Double-blinded Randomized Clinical Trial

TypeinterventionalSponsorMedical University of ViennaRan2020 to 2024Enrolled230ConditionsCardiovascular Risk FactorArmsLevosimendan, Placebo
NCT04648332 nacompletednot on this mapstarted 2018, after this paper: background citation

Compartment Psoas Block Efficacy and Safety for Perioperative Analgesia in the Elderly With Proximal Femur Fractures: a Randomized Controlled Study

TypeinterventionalSponsorBogomolets National Medical UniversityRan2018 to 2019Enrolled90ConditionsFemur FractureArmsBupivacaine Hydrochloride
NCT04753307 unknown statusnot on this mapstarted 2021, after this paper: background citation

Perioperative Inflammatory Response Assessment in High-risk Patients Undergoing Noncardiac Surgery - a Prospective Non-interventional Observational Study

TypeobservationalSponsorMedical University of ViennaRan2021 to 2025Enrolled1,400ConditionsPostoperative Complications, Cardiovascular Complication, Myocardial Ischemia, InflammationArmsLaboratory measurements
NCT05333120 unknown statusnot on this mapstarted 2021, after this paper: background citation

A Clinical Multicenter, Prospective, Observational Cohort Study to Validate a Prediction Mobile APP for Perioperative Hypothermia

Typeobservational_patient_registrySponsorPeking Union Medical College HospitalRan2021 to 2023Enrolled3,000ConditionsPerioperative Hypothermia
NCT05352698 completednot on this mapstarted 2022, after this paper: background citation

Validation of B-type Natriuretic Peptide With N-terminal Pro B-type Natriuretic Peptide in Perioperative Risk Assessment

TypeobservationalSponsorJordan LeitchRan2022 to 2023Enrolled466ConditionsPerioperative CareArmsNT ProBNP (Roche)
NCT05733208 naactive not recruitingnot on this mapstarted 2023, after this paper: background citation

The Effect of Remote Ischemic Preconditioning on Myocardial Injury After Noncardiac Surgery in Patients at a High Risk of Cardiac Events

TypeinterventionalSponsorSixth Affiliated Hospital, Sun Yat-sen UniversityRan2023 to 2026Enrolled766ConditionsMyocardial Injury, Non-cardiac Surgery, Remote Ischemic PreconditioningArmsRemote ischemic preconditioning, Sham-remote ischemic preconditioning
NCT05907941 naunknown statusnot on this mapstarted 2024, after this paper: background citation

Closed Incision Negative Pressure Therapy Compared to Conventional Dressing Following Autologous Abdominal Tissue Breast Reconstruction: A Randomized Control Trial

TypeinterventionalSponsorMcMaster UniversityRan2024 to 2026Enrolled114ConditionsBreast Cancer, Wound Dehiscence, SurgicalArmsciNPT, Conventional Tape Dressings, DIEP Breast Reconstruction
NCT06291714 narecruitingnot on this mapstarted 2024, after this paper: background citation

Prospective Interventional Study Investigating a Goal-directed Therapy Based on Non-invasive Measurement of the Hypotension Prediction Index for the Reduction of Hypotension in Patients Undergoing Major Orthopedic and Trauma Surgery

TypeinterventionalSponsorUniversity of GiessenRan2024 to 2026Enrolled150ConditionsIntraoperative Hypotension, Acute Kidney Injury, Myocardial Injury After Non-cardiac SurgeryArmsGDT-based hemodynamic management based on Clearsight device
NCT06944301 nanot yet recruitingnot on this mapstarted 2025, after this paper: background citation

Comparison of Myocardial Injury After Noncardiac Surgery (MINS) Incidence in Supine vs. Prone Positioning During Percutaneous Nephrolithotomy (PNL)

TypeinterventionalSponsorMedipol UniversityRan2025 to 2026Enrolled400ConditionsMINS, Myocardial Injury After Noncardiac Surgery, Myocardial Injury After Noncardiac Surgery (MINS), Renal CalculiArmsblood sampling
NCT07523321 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Effect of Perioperative Use of Dexmedetomidine-esketamine Combination on Incidence of Moderate-to-severe Pain After Spinal Surgery: a Randomized Controlled Trial

TypeinterventionalSponsorPeking University First HospitalRan2026 to 2027Enrolled274ConditionsSpinal Surgery, Pain Intensity, Dexmedetomidine, EsketamineArmsCombined dexmedetomidine-esketamine administration, Placebo administration
NCT07525999 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Effect of Perioperative Use of Dexmedetomidine-esketamine Combination on Incidence of Chronic Postsurgical Pain After Spinal Surgery: a Randomized Controlled Trial

TypeinterventionalSponsorPeking University First HospitalRan2026 to 2027Enrolled274ConditionsSpinal Surgery, Pain Intensity, Dexmedetomidine, EsketamineArmsCombined dexmedetomidine-esketamine administration, Placebo administration
NCT07539532 recruitingnot on this mapstarted 2026, after this paper: background citation

Value of Some Risk Scores in Predicting Cardiovascular Events After Gastrointestinal Surgery

Typeobservational_patient_registrySponsorBach Mai HospitalRan2026 to 2026Enrolled5,000ConditionsPostoperative Complications, Cardiovascular Diseases, Digestive System Surgical Procedures
3 · Its place in the literature

Who cites it

325 citing papers in PubMed, 7 syntheses or guidelines pooled it, 887 citations in OpenAlex.

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265 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

54 authors at 20 institutions in 16 countries.

Writing Committee for the VISION Study Investigators
P J DevereauxMcMaster University, Hamilton, Ontario, Canada.
Bruce M BiccardUniversity of Cape Town, Cape Town, South Africa.
Alben SigamaniNarayana Hrudayalaya Limited, Bangalore, Karnataka, India.
Denis XavierSt John's Medical College and Research Institute, Bangalore, India.
Matthew T V ChanChinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Sadeesh K SrinathanWinnipeg Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
Michael WalshMcMaster University, Hamilton, Ontario, Canada.
Valsa AbrahamChristian Medical College, Ludhiana, Punjab, India.
Rupert PearseBarts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England.
C Y WangUniversity of Malaya, Kuala Lumpur, Malaysia.
Daniel I SesslerCleveland Clinic, Cleveland, Ohio.
Andrea KurzCleveland Clinic, Cleveland, Ohio.
Wojciech SzczeklikJagiellonian University Medical College, Krakow, Poland.
Otavio BerwangerResearch Institute Hcor (Hospital do Coracao), Sao Paulo, Brazil.
Juan Carlos VillarUniversidad Autónoma de Bucaramanga and Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
German MalagaUniversidad Peruana Cayetano Heredia, Lima, Peru.
Amit X GargWestern University, London, Ontario, Canada.
Clara K ChowThe George Institute for Global Health, Westmead Hospital, University of Sydney, Sydney, Australia.
Gareth AcklandUniversity College Hospital NHS Trust and William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.
Ameen PatelMcMaster University, Hamilton, Ontario, Canada.
Flavia Kessler BorgesUniversidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Emilie P Belley-CoteMcMaster University, Hamilton, Ontario, Canada.
Emmanuelle DuceppeMcMaster University, Hamilton, Ontario, Canada.
Jessica SpenceMcMaster University, Hamilton, Ontario, Canada.
Vikas TandonMcMaster University, Hamilton, Ontario, Canada.
Colin WilliamsRoyal Liverpool and Broadgreen University Hospitals, Liverpool, England.
Robert J SapsfordLeeds Teaching Hospitals NHS Trust, Leeds, England.
Carisi A PolanczykFederal University of Rio Grande do Sul and Hospital Moinhos de Vento, Porto Alegre, Brazil.
Maria TiboniMcMaster University, Hamilton, Ontario, Canada.
Pablo Alonso-CoelloIberoamerican Cochrane Center (IIB Sant Pau-CIBERESP), Hospital Sant Pau, Barcelona, Spain.
Atiya FaruquiSt John's Medical College and Research Institute, Bangalore, India.
Diane Heels-AnsdellMcMaster University, Hamilton, Ontario, Canada.
Andre LamyMcMaster University, Hamilton, Ontario, Canada.
Richard WhitlockMcMaster University, Hamilton, Ontario, Canada.
Yannick LeManachMcMaster University, Hamilton, Ontario, Canada.
Pavel S RoshanovMcMaster University, Hamilton, Ontario, Canada.
Michael McGillionMcMaster University, Hamilton, Ontario, Canada.
Peter KavsakMcMaster University, Hamilton, Ontario, Canada.
Matthew J McQueenMcMaster University, Hamilton, Ontario, Canada.
Lehana ThabaneMcMaster University, Hamilton, Ontario, Canada.
Reitze N RodsethUniversity of KwaZulu-Natal, Pietermaritzburg, South Africa.
Giovanna A Lurati BuseUniversity Hospital Düsseldorf, Düsseldorf, Germany.
Mohit BhandariMcMaster University, Hamilton, Ontario, Canada.
Ignacia GaruttiHospital Universitario Gregorio Marañón, Madrid, Spain.
Michael J JackaUniversity of Alberta, Edmonton, Alberta, Canada.
Holger J SchünemannMcMaster University, Hamilton, Ontario, Canada.
Olga Lucía CortesFundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
Pierre CoriatUniversite Pierre et Marie Curie, Paris, France.
Nazari DvirnikMcMaster University, Hamilton, Ontario, Canada.
Fernando BottoHospital Universitario Austral, Pilar, Buenos Aires, Argentina.
Shirley PettitMcMaster University, Hamilton, Ontario, Canada.
Allan S JaffeMayo Clinic, Rochester, Minnesota.
Gordon H GuyattMcMaster University, Hamilton, Ontario, Canada.
McMaster University · CACleveland Clinic · USSt.John's Medical College Hospital · INChinese University of Hong Kong · HKChristian Medical College, Vellore · INHealth Sciences Centre · CAHeinrich Heine University Düsseldorf · DEHospital do Coração · BRHospital General Universitario Gregorio Marañón · ESHospital Universitario Austral · ARIberoamerican Cochrane Centre · ESInstitute of Cardiology · COJagiellonian University · PLLeeds Teaching Hospitals NHS Trust · GBMayo Clinic · USNarayana Health · INQueen Mary University of London · GBRoyal Liverpool and Broadgreen University Hospital NHS Trust · GBSorbonne Université · FRUniversidad Autónoma de Bucaramanga · CO

Funding

Department of Health RP_2014-04-022
6 · The paper itself

Abstract

importanceLittle is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS).

objectiveTo determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). DESIGN, SETTING, AND

participantsProspective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013. EXPOSURES: Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement. MAIN OUTCOMES AND MEASURES: A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-day mortality of 3% or higher. To determine potential diagnostic criteria for MINS, regression analyses ascertained if postoperative hsTnT elevations required an ischemic feature (eg, ischemic symptom or electrocardiography finding) to be associated with 30-day mortality.

resultsAmong 21 842 participants, the mean age was 63.1 (SD, 10.7) years and 49.1% were female. Death within 30 days after surgery occurred in 266 patients (1.2%; 95% CI, 1.1%-1.4%). Multivariable analysis demonstrated that compared with the reference group (peak hsTnT <5 ng/L), peak postoperative hsTnT levels of 20 to less than 65 ng/L, 65 to less than 1000 ng/L, and 1000 ng/L or higher had 30-day mortality rates of 3.0% (123/4049; 95% CI, 2.6%-3.6%), 9.1% (102/1118; 95% CI, 7.6%-11.0%), and 29.6% (16/54; 95% CI, 19.1%-42.8%), with corresponding adjusted HRs of 23.63 (95% CI, 10.32-54.09), 70.34 (95% CI, 30.60-161.71), and 227.01 (95% CI, 87.35-589.92), respectively. An absolute hsTnT change of 5 ng/L or higher was associated with an increased risk of 30-day mortality (adjusted HR, 4.69; 95% CI, 3.52-6.25). An elevated postoperative hsTnT (ie, 20 to <65 ng/L with an absolute change ≥5 ng/L or hsTnT ≥65 ng/L) without an ischemic feature was associated with 30-day mortality (adjusted HR, 3.20; 95% CI, 2.37-4.32). Among the 3904 patients (17.9%; 95% CI, 17.4%-18.4%) with MINS, 3633 (93.1%; 95% CI, 92.2%-93.8%) did not experience an ischemic symptom. CONCLUSIONS AND RELEVANCE: Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.

Indexed as

AgedFemaleHumansMaleMiddle AgedMyocardial InfarctionMyocardial IschemiaPostoperative ComplicationsPostoperative PeriodProspective StudiesRisk AssessmentTroponin TTroponin T

Identifiers

PMID28444280
OpenAlexW2608174232

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.