Researchers at McMaster University have found a test that can identify people who are at high risk of dying in the month after surgery. Apparently elevated levels of troponin T (a protein marker of heart injury) correlate with an increased risk of death.
Currently, troponin levels are not commonly measured after most types of surgery.
The results from the Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION) study, the largest international prospective study evaluating complications after surgery, have just been published in the Journal of the American Medical Association (JAMA).
VISION enrolled 15,133 adult patients in North and South America, Asia, Australia, and Europe. Troponin T was measured daily during the first three days after surgery. Patients were followed while in the hospital and at 30 days after surgery.
“VISION demonstrated that a simple blood test strongly identifies which non-cardiac surgery patients are at high risk of dying in the next 30 days,” said Dr. P.J. Devereaux, VISION principal investigator.
According to Devereaux the results also demonstrated that most patients did not die until an average of six or more days after their troponin T blood test was identified as elevated. “This holds out great hope that there is time to intervene.”
Surgery activates pathways of inflammation, stress, and clotting that predispose the heart to injury. As a result, many patients suffer heart attacks after surgery. The majority of these patients, however, will not experience chest pain. Evidence from this study supports experts who have advocated the use of troponin blood tests after surgery.
The VISION study suggests that myocardial injury detected through elevated troponin T may explain 42% of deaths that occur after surgery.
“This study has substantial potential to change how patients are monitored after surgery,” said Dr. Jean Rouleau, scientific director of the Institute for Circulatory and Respiratory Health of the Canadian Institutes of Health Research. “These results hold substantial promise that through measuring troponin blood tests after surgery, physicians can identify which patients are at high-risk of dying and this can allow them to consider enhanced monitoring and interventions in an attempt to improve outcomes. This is a good example of how a carefully conducted clinical study can impact patient care.”
SRxA’s Word on Health would like to know if you would take the test.