ArticleBMC anesthesiology2025
High sensitivity troponin-I and myocardial injury after noncardiac surgery for cancer in a large prospective cohort.
Article in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMyocardial injury after noncardiac surgery (MINS) impact in cancer is unclear. In a general population, high-sensitivity troponin-I assays (hsTnI) have better MINS detection than contemporary troponin-I (TnI) assays. This study summarizes MINS prevalence in cancer surgery patients using hsTnI and TnI. The primary endpoint was 30-day mortality. Secondary endpoints included 90-day mortality, and observed-to-expected length of stay ratio [O: E LOS].
methodsMINS was explored using three postoperative elevation definitions: MINSTnI: TnI ≥ 0.06 ng/mL, MINShsTnI: hsTnI ≥ 17 ng/L (female) ≥ 35 ng/L (male), or MINSeither: MINSTnI or MINShsTnI. MINS and patient characteristics were analyzed for univariable associations with 30-day mortality using logistic regression. The association between MINS and cardiotoxic cancer therapy was assessed with Chi-squared test, and association with secondary endpoints were quantified with regression analyses.
resultsAmong 4,278 patients, prevalence of MINSTnI, MINShsTnI, and MINSeither were 4.6%, 9.3%, and 9.5%. In univariable analysis, MINShsTnI was associated with greater odds of 30-day mortality (OR 3.3; 95% CI 1.07, 8.57, p = 0.039), but association with MINSTnI was not detected (OR 3.67; 95% CI 0.85, 11.0, p = 0.076). In multivariable Cox analysis, association between MINShsTnI and 90-day mortality was not detected (HR 1.46, 95% CI 0.78, 2.71, p = 0.2). Cardiotoxic cancer therapy had increased odds of 30-day mortality in univariable analysis (OR 3.20; 95% CI 1.25, 7.75, p = 0.017) and higher MINShsTnI prevalence versus non-exposed patients (12% vs. 9%, p = 0.015). Patients with MINShsTnI had a 25% (95% CI 16%, 32%, p < 0.001) higher O: E LOS ratio.
conclusionThis study of MINS in cancer surgery observed increased odds of 30-day mortality in univariable analysis. An association with 90-day mortality, however, was not detected in multivariable analysis. MINS was associated with an increased O: E LOS ratio. As expected, the hsTnI assay detected more MINS events. The relationship of cardiotoxic cancer therapies to MINS risk warrants investigation.
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