Comparison of High-Sensitivity Troponin T Versus N-Terminal Pro-B-Type Natriuretic Peptide for Prediction of Major Adverse Cardiovascular Events After Noncardiac Surgery.
TL;DR
Hs-TnT and NT-proBNP were associated with major adverse cardiovascular events and death, but their contribution to risk prediction over Revised Cardiac Risk Index and age was limited.
Abstract
Background
Preoperative hs-TnT (high-sensitivity cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) are used for risk prediction in noncardiac surgery. While the European Society of Cardiology recommends hs-TnT, American Cardiology and European anesthesiology societies support NT-proBNP. Direct comparisons of their predictive performance are limited. This study compares preoperative hs-TnT and NT-proBNP in predicting cardiac events after noncardiac surgery.
Methods
This secondary analysis pooled data from the METREPAIR (Metabolic Equivalents: Reevaluation for Perioperative Cardiac Risk) and MINSS (Myocardial Injury in Noncardiac Surgery in Sweden) studies involving patients with elevated cardiovascular risk undergoing elective noncardiac surgery. The primary end point was the incidence of 30-day major adverse cardiovascular events, with 30-day death as the secondary end point. Logistic regression models, including Revised Cardiac Risk Index (RCRI) and age, were augmented by biomarkers. Prediction was assessed using area under the receiver operating characteristic curve, calibration slopes, and Brier scores. Decision curve analysis was conducted at predefined thresholds for major adverse cardiovascular events and death.
Results
Among 2251 patients, MACE occurred in 5.8% (131/2251) and death in 1.6% (37/2251). Both biomarkers were significantly associated with outcomes. Only hs-TnT improved discrimination for predicting death (area under the receiver operating characteristic curveRCRI+age+hsTnT=0.680 versus area under the receiver operating characteristic curveRCRI+age=0.674; Δ area under the curve: 0.006; P=0.047). Brier scores and calibration slopes showed good calibration for all models. Benefit equivalents of RCRI+hs-TnT versus RCRI+NT-proBNP were -0.06 per 1000 and -0.17 per 1000 for major adverse cardiovascular events and +0.06 per 1000 versus -0.08 per 1000 (5% threshold) and -0.35 per 1000 versus -0.06 per 1000 (10% threshold) for death. A literature review did not suggest differences between biomarkers.
Conclusions
Hs-TnT and NT-proBNP were associated with major adverse cardiovascular events and death, but their contribution to risk prediction over RCRI and age was limited. No significant difference was found between biomarkers.