Perioperative medicine & outcomes
Postoperative elevated cardiac troponin levels predict all-cause mortality and major adverse cardiovascular events following noncardiac surgery: A dose-response meta-analysis of prospective studies
Pooled result · All-cause mortalityResult — go to the resultUnadj OR 1.80 95% CI 1.63–1.99Authors' conclusion
This study shows positive WL or GL and RCS dose-response relationships between PMI and all-cause mortality at short (< 12 mons)- and long-term (≥ 12 mons) follow-up, and MACE at longest follow-up. For mild cTn increase below URL, the risk of mortality also increases even with every increment of 0.25× URL.
Study context
- Population
- Adults undergoing noncardiac surgery, teaching hospitals
- Participants
- 53,518 adults · 29 studies
- Comparison
- Postoperative myocardial injury (PMI) vs no PMI after noncardiac surgery
- Outcome
- All-cause mortality
Methodological detailsweighted (WL) or generalized (GL) linear and restricted cubic spline (RCS) regression
- Weighted (WL) or generalized (GL) linear and restricted cubic spline (RCS) regression
Pooled result
As reported in the abstract
Unadj OR
1.80
95% CI 1.63–1.99
P < 0.001
Further pooled results
Overall incidence of PMI
- Overall incidence of PMI
- 26.0% (95% CI 21.0% to 32.0%)
Dose-response, all-cause mortality per 1× URL increment, short-term (unadj OR)
- WL, OR
- 1.09 (95% CI 1.09 to 1.10)
- GL, OR
- 1.06 (95% CI 1.06 to 1.07)
- RCS, 1-2× URL, OR
- 2.43 (95%CI 2.25 to 2.62)
- All P < 0.001
Dose-response, all-cause mortality per 1× URL increment, long-term (unadj HR)
- WL, OR
- 1.16 (95% CI 1.14 to 1.17)
- GL, OR
- 1.15 (95% CI 1.13 to 1.16)
- RCS, 1-2.75× URL, OR
- 1.23 (95%CI 1.13 to 1.33)
- All P < 0.001
Dose-response, MACE per 1× URL increment (unadj OR) · longest follow-up
- WL, OR
- 1.53 (95% CI 1.49 to 1.57)
- GL, OR
- 1.46 (95% CI 1.42 to 1.50)
- RCS, 1-2 x URL, OR
- 3.10 (95%CI 2.51 to 3.81)
- All P < 0.001
Mortality per 0.25xURL increment, mild cTn increase below URL
- WL, OR
- 1.03 (95% CI 1.02 to 1.03)
- GL, OR
- 1.05 (95% CI 1.03 to 1.07)
- RCS, 0-0.5 URL, OR
- 9.41 (95% CI 7.41 to 11.95)
- All P < 0.001
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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