Postoperative troponin surveillance to detect myocardial infarction: an observational cohort modelling study
Authors' conclusion
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.
Study context
- Population
- Patients after noncardiac surgeryMETS and TEAMS
- Participants
- 2,350 patients
- Exposure
- American, Canadian and European guideline recommendations for troponin surveillance vs the authors' risk stratification model
- Outcome
- Detection of POMI by each strategy: number of patients requiring monitoring, % POMI detected, sensitivity, specificity, diagnostic odds ratio, number needed to screen (NNS)
Methodological detailsdata from two prospective studies (METS and TEAMS)
- Data from two prospective studies (METS and TEAMS)
Main finding
As reported in the abstract
Selection for troponin monitoring and POMI detection
| Group | Value | Diagnostic odds ratio | Number needed to screen (NNS) | Sensitivity | Specificity |
|---|---|---|---|---|---|
| Risk stratification model | 20% | 2.5 (95% CI 1.4-4.2) | 21 | ||
| Canadian guidelines | 78% | 0.85 (95% CI 0.74-0.92) | |||
| European guidelines | 79% | 0.85 (95% CI 0.74-0.92) | |||
| American guidelines | 0.91 (95% CI 0.90-0.92) |
Value
Risk stratification model20%
Canadian guidelines78%
European guidelines79%
American guidelines— not stated in the abstract
Diagnostic odds ratio
Risk stratification model2.5 (95% CI 1.4-4.2)
Canadian guidelines— not stated in the abstract
European guidelines— not stated in the abstract
American guidelines— not stated in the abstract
Number needed to screen (NNS)
Risk stratification model21
Canadian guidelines— not stated in the abstract
European guidelines— not stated in the abstract
American guidelines— not stated in the abstract
Sensitivity
Risk stratification model— not stated in the abstract
Canadian guidelines0.85 (95% CI 0.74-0.92)
European guidelines0.85 (95% CI 0.74-0.92)
American guidelines— not stated in the abstract
Specificity
Risk stratification model— not stated in the abstract
Canadian guidelines— not stated in the abstract
European guidelines— not stated in the abstract
American guidelines0.91 (95% CI 0.90-0.92)
Observational data: associations, not effects.
Further findings
Cohort outcomes
- Myocardial injury
- 319 (14%)
- POMI
- 61 (2.5%)
- Died
- 14 (0.6%)
Original publication
Postoperative troponin surveillance to detect myocardial infarction: an observational cohort modelling study. Br J Anaesth. Published 16 January 2024. doi:10.
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