Vladimir Lomivorotov, Doctor of Medical Sciences, Corresponding Member of the Russian Academy of Sciences, Head of National Medical Research Center Research Department of Anesthesiology and Resuscitation (Meshalkina Clinic), and Professor at the NSU`s V. Zelman Institute of Medicine and Psychology, was a member of a team conducting a large scale international, multicenter study.
This research scientifically confirmed the relationship between the postoperative level of highly sensitive troponin and the clinical outcome in patients undergoing cardiac surgery. This raised the question of changing the border troponin levels for the diagnosis of perioperative myocardial infarction. The immediate influence is changing the routine practice of anesthesiologists-resuscitators in the diagnosis and prevention of perioperative myocardial infarction. In the future, the data obtained will make it possible to determine a new, higher limit for the troponin level.
The study involved 13,862 patients who underwent cardiac surgery (North America: 35.9%, Asia: 28.3%, Europe: 26.2%, South America: 6.3%, and Australia: 3.3%). This included 1,026 patients at the Meshalkina Clinic. The research was designed to test the hypothesis that more than 10 times the upper limit of a normal (34.2 ng/l) troponin concentration after cardiac surgery in combination with ischemic changes on the electrocardiogram or echocardiogram indicates myocardial infarction. This is associated with an increased risk of mortality within 30 days. Every subject measured their cardiac troponin at several critical points: 3-12 hours after surgery and on the first, second, and third days after surgery.
Lomivorotov detailed the results,
Over the course of the study, we noticed that the lowest troponin concentration thresholds associated with 30-day mortality are significantly higher than those used as the basis for diagnosing perioperative myocardial infarction. Thus, among patients who underwent isolated coronary artery bypass grafting, the threshold value of troponin was 5670 ng/l (218 times higher than the upper reference limit) the first day after surgery. Among patients who underwent other cardiac surgery, it was 12,981 ng/l (499 times higher than the upper reference limit).
The findings were published in The New England Journal of Medicine (Q1), the most widely read, cited, and influential general medicine periodical in the world. The results will enable critical care anesthesiologists to focus on patients with high postoperative troponin to prevent cardiovascular complications.
