The Role of Troponin-T Biomarker as an Indicator for Cardiac and Non-Cardiac Complications in Cardiac Patients Undergoing Non-Cardiac Surgery at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
-
Muhammad Ridha Zulfikar
,
Nur Surya Wirawan
,
Syafri Kamsul Arif
,
Syafruddin Gaus
,
Haizah Nurdin
,
Andi Adil
Abstract
Background: Non-cardiac surgery in patients with cardiovascular risk can lead to postoperative complications. Troponin T, a cardiac biomarker, is proposed as an indicator of cardiac risk in these patients. This study evaluates troponin T levels before and after non-cardiac surgery and their association with postoperative complications.
Methods: This prospective cohort study included 46 patients selected through consecutive sampling. Demographic data and troponin T levels were recorded before and 24 hours after surgery.
Results: Postoperative complications included cardiac events (15.21%), such as myocardial infarction (4.34%), heart failure (4.34%), and arrhythmia (6.52%), and non-cardiac events (17.39%), such as sepsis (4.34%), bleeding (4.34%), surgical site infection (6.52%), and respiratory insufficiency (2.17%). The average patient age was 50.15 ± 8.81 years, with 60.9% being male. There was a significant relationship between troponin T levels and the incidence of cardiac complications after surgery.
Conclusion: Elevated postoperative troponin T levels may serve as a prognostic indicator for cardiac complications in non-cardiac surgery patients. Routine monitoring could aid in early detection and improved postoperative management.
[1] Lerman BJ, Popat RA, Assimes TL, Heidenreich PA, Wren SM. Association of Left Ventricular Ejection Fraction and Symptoms with Mortality after Elective Noncardiac Surgery among Patients with Heart Failure. JAMA - J Am Med Assoc. 2019; 321(6):572-579.
[2] Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A. Correspondence Global burden of postoperative death. Lancet. 2019; 393:401.
[3] Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012; 380(9847):1059-1065.
[4] Karnina R, Irawany V, Manggala SK, Aulya JU, Faruk M. The role of continuous renal replacement therapy in the management of cardiorenal syndrome involving acute myocardial infarction with concomitant pneumonia: case report. Pan Afr Med J. 2024;49:30.
[5] Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol. 2017; 33(1):17-32.
[6] Yurttas T, Hidvegi R, Filipovic M. Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery. J Clin Med. 2020;9(2):1-10.
[7] Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-Specific Troponin I Levels to Predict the Risk of Mortality in Patients with Acute Coronary Syndromes. N Engl J Med. 1996;335(18):1342-1349.
[8] Nagele P, Brown F, Gage BF, Gibson DW, Miller JP, Jaffe AS, et al. High-Sensitivity Cardiac Troponin T in Prediction and Diagnosis of Myocardial Infarction and Long-Term Mortality after Non-Cardiac Surgery. Natl Inst Health. 2013;23(1):1-7.
[9] Weber M, Luchner A, Seeberger M, Mueller C, Liebetrau C, Schlitt A, et al. Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery. Eur Heart J. 2013;34(11):853-862.
[10] Tevaearai Stahel HT, Do PD, Klaus JB, Gahl B, Locca D, et al. Clinical Relevance of Troponin T Profile Following Cardiac Surgery. Front Cardiovasc Med. 2018; 5:182.
[11] Arnott C, Li Q, Kang A, Neuen BL, Bompoint S, Lam CSP, et al. Sodium-Glucose Cotransporter 2 Inhibition for the Prevention of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2020;9(3).:e014908.
[12] Heianza Y, Ma W, Manson JAE, Rexrode KM, Qi L. Gut Microbiota Metabolites and Risk of Major Adverse Cardiovascular Disease Events and Death: A Systematic Review and Meta-Analysis of Prospective Studies. J Am Heart Assoc. 2017;6(7):1-28.
[13] Lin Z, Lim SH, Chua SJT, Tai ES, Chan YH, Richards AM. High-sensitivity troponin T and long-term adverse cardiac events among patients presenting with suspected acute coronary syndrome in Singapore. Singapore Med J. 2019; 60(8):418-426.
[14] Chenevier-Gobeaux C, Bonnefoy-Cudraz É, Charpentier S, Dehoux M, Lefevre G, Meune C, et al. High-sensitivity cardiac troponin assays: answers to frequently asked questions. Arch Cardiovasc Dis. 2015;108(2):132-49.
[15] Indrawijaya YYA, Suharjono S, Aminuddin M, Retnowati E, Rahman GM. Changes on Serum Troponin T Level before and after Taking Standard Therapy Medication in Heart Failure Patients. Folia Medica Indones. 2020;56(1):4-14.
[16] Horr S, Reed G, Menon V. Troponin elevation after noncardiac surgery: Significance and management. Cleve Clin J Med. 2015; 82(9):595-602.
[17] Bollen Pinto B, Ackland GL. Pathophysiological mechanisms underlying increased circulating cardiac troponin in noncardiac surgery: a narrative review. Br J Anaesth. 2024;132(4):653-666.
[18] Noordzij PG, van Geffen O, Dijkstra IM, Boerma D, Meinders AJ, Rettig TC, et al. High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery. Br J Anaesth. 2015;114(6):909-918.
[19] Chew MS, Saugel B, Lurati-Buse G. Perioperative troponin surveillance in major noncardiac surgery: a narrative review. Br J Anaesth. 2023;130(1):21-28.
[20] Ackland GL, Abbott TEF, Jones TF, Leuwer M, Pearse RM. Early elevation in plasma high-sensitivity troponin T and morbidity after elective noncardiac surgery: prospective multicentre observational cohort study. Br J Anaesth. 2020;124(5):535-543.
[2] Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A. Correspondence Global burden of postoperative death. Lancet. 2019; 393:401.
[3] Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012; 380(9847):1059-1065.
[4] Karnina R, Irawany V, Manggala SK, Aulya JU, Faruk M. The role of continuous renal replacement therapy in the management of cardiorenal syndrome involving acute myocardial infarction with concomitant pneumonia: case report. Pan Afr Med J. 2024;49:30.
[5] Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol. 2017; 33(1):17-32.
[6] Yurttas T, Hidvegi R, Filipovic M. Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery. J Clin Med. 2020;9(2):1-10.
[7] Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-Specific Troponin I Levels to Predict the Risk of Mortality in Patients with Acute Coronary Syndromes. N Engl J Med. 1996;335(18):1342-1349.
[8] Nagele P, Brown F, Gage BF, Gibson DW, Miller JP, Jaffe AS, et al. High-Sensitivity Cardiac Troponin T in Prediction and Diagnosis of Myocardial Infarction and Long-Term Mortality after Non-Cardiac Surgery. Natl Inst Health. 2013;23(1):1-7.
[9] Weber M, Luchner A, Seeberger M, Mueller C, Liebetrau C, Schlitt A, et al. Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery. Eur Heart J. 2013;34(11):853-862.
[10] Tevaearai Stahel HT, Do PD, Klaus JB, Gahl B, Locca D, et al. Clinical Relevance of Troponin T Profile Following Cardiac Surgery. Front Cardiovasc Med. 2018; 5:182.
[11] Arnott C, Li Q, Kang A, Neuen BL, Bompoint S, Lam CSP, et al. Sodium-Glucose Cotransporter 2 Inhibition for the Prevention of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2020;9(3).:e014908.
[12] Heianza Y, Ma W, Manson JAE, Rexrode KM, Qi L. Gut Microbiota Metabolites and Risk of Major Adverse Cardiovascular Disease Events and Death: A Systematic Review and Meta-Analysis of Prospective Studies. J Am Heart Assoc. 2017;6(7):1-28.
[13] Lin Z, Lim SH, Chua SJT, Tai ES, Chan YH, Richards AM. High-sensitivity troponin T and long-term adverse cardiac events among patients presenting with suspected acute coronary syndrome in Singapore. Singapore Med J. 2019; 60(8):418-426.
[14] Chenevier-Gobeaux C, Bonnefoy-Cudraz É, Charpentier S, Dehoux M, Lefevre G, Meune C, et al. High-sensitivity cardiac troponin assays: answers to frequently asked questions. Arch Cardiovasc Dis. 2015;108(2):132-49.
[15] Indrawijaya YYA, Suharjono S, Aminuddin M, Retnowati E, Rahman GM. Changes on Serum Troponin T Level before and after Taking Standard Therapy Medication in Heart Failure Patients. Folia Medica Indones. 2020;56(1):4-14.
[16] Horr S, Reed G, Menon V. Troponin elevation after noncardiac surgery: Significance and management. Cleve Clin J Med. 2015; 82(9):595-602.
[17] Bollen Pinto B, Ackland GL. Pathophysiological mechanisms underlying increased circulating cardiac troponin in noncardiac surgery: a narrative review. Br J Anaesth. 2024;132(4):653-666.
[18] Noordzij PG, van Geffen O, Dijkstra IM, Boerma D, Meinders AJ, Rettig TC, et al. High-sensitive cardiac troponin T measurements in prediction of non-cardiac complications after major abdominal surgery. Br J Anaesth. 2015;114(6):909-918.
[19] Chew MS, Saugel B, Lurati-Buse G. Perioperative troponin surveillance in major noncardiac surgery: a narrative review. Br J Anaesth. 2023;130(1):21-28.
[20] Ackland GL, Abbott TEF, Jones TF, Leuwer M, Pearse RM. Early elevation in plasma high-sensitivity troponin T and morbidity after elective noncardiac surgery: prospective multicentre observational cohort study. Br J Anaesth. 2020;124(5):535-543.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Troponin T Cardiac complications Non-cardiac surgery Biomarkers Cardiovascular risk. | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Zulfikar M, Wirawan NS, Arif S, Gaus S, Nurdin H, Adil A. The Role of Troponin-T Biomarker as an Indicator for Cardiac and Non-Cardiac Complications in Cardiac Patients Undergoing Non-Cardiac Surgery at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Arch Anesth & Crit Care. 2025;.
