High sensitivity troponin-I and myocardial injury after noncardiac surgery for cancer in a large prospective cohort.

BACKGROUND

Myocardial 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].

METHODS

MINS 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.

RESULTS

Among 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.

CONCLUSION

This 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.