Does studies such as this one change your practice in this area? How would you implement this if it does? Are there barriers to implementation?

Given the large sample size and results is there need for more reseach around the association between tropinin and mortality? If so what questions are still needing validation?

Do you use troponin screening in your current practice? If so in what way? Is 4th generation TnT avalable to you?

Hi all,

For our next paper we will look at a large study done at McMaster University on post non-cardiac surgery troponin levels. This study is interesting as it gives us guidence on how to interpret post op troponin elevation and there prognostic value. It is an international prospective cohort study that included 15,133 patients and its primary outcome was 30 day mortality.  They showed that mortality at 30 days was significantly associated with a troponin rise in the first three post operative days. More over they showed that only mildly elevated TnT (troponin T) levels of less than 0.04 ng/mL were associated with significant risks. More specifically 1 in 25 patients with a peak of 0.02, 1 in 11 of a peak of 0.02-0.029 and 1 in 6 of 0.03 ng/mL will die within 30 days of surgery.

Learning Objectives:

1) To review recent evidence on post operative troponin levels

2)To comment on study design and outcomes

3)To comment on applicability of the study to your patient population

ARTICLE:

Devereaux PJ, Chan MT, Alonso-Coello P,  et al; Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators.  Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery.  JAMA. 2012. 307(21):2295-2304. Use this link to access the article: https://blogs.ubc.ca/imjournalclub/files/2013/02/Session-4.pdf

Please stay tuned! Session 4 will run for six weeks starting on February 25, 2013.

Session 4 topic: Mortality Among Patients Undergoing Noncardiac Surgery.