Background: There is uncertainty regarding the prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurements after noncardiac surgery. Methods: The current study undertook a systematic review and meta-analysis. The study used six search strategies and included noncardiac surgery studies that provided data from a multivariable analysis assessing whether a postoperative troponin or creatine kinase muscle and brain isoenzyme measurement was an independent predictor of mortality or a major cardiovascular event. Independent investigators determined study eligibility and abstracted data in duplicate. Results: Fourteen studies, enrolling 3,318 patients and 459 deaths, demonstrated that an increased troponin measurement after surgery was an independent predictor of mortality (odds ratio [OR] 3.4, 95% confidence interval [CI] 2.2-5.2), but there was substantial heterogeneity (I = 56%). The independent prognostic capabilities of an increased troponin value after surgery in the 10 studies that assessed intermediate-term (≤ 12 months) mortality was an OR = 6.7 (95% CI 4.1-10.9, I = 0%) and in the 4 studies that assessed long-term (more than 12 months) mortality was an OR = 1.8 (95% CI 1.4-2.3, I = 0%; P < 0.001 for test of interaction). Four studies, including 1,165 patients and 202 deaths, demonstrated an independent association between an increased creatine kinase muscle and brain isoenzyme measurement after surgery and mortality (OR 2.5, 95% CI 1.5-4.0, I = 4%). Conclusions: An increased troponin measurement after surgery is an independent predictor of mortality, particularly within the first year; limited data suggest an increased creatine kinase muscle and brain isoenzyme measurement also predicts subsequent mortality. Monitoring troponin measurements after noncardiac surgery may allow physicians to better risk stratify and manage their patients.
Bibliographical noteFunding Information:
Received from the Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada. Submitted for publication June 25, 2010. Accepted for publication November 4, 2010. This systematic review was funded through a Regional Medical Association grant (Hamilton, Ontario, Canada). Drs. Bhandari and Cook are supported by a Canadian Research Chair (Hamilton, Ontario, Canada). Dr. Yusuf is supported by a Heart and Stroke Foundation Endowed Chair in Cardiovascular Research (Hamilton, Ontario, Canada). Dr. Schünemann is supported by an endowed chair (Hamilton, Ontario, Canada). Dr. Devereaux is supported by a Canadian Institutes of Health Research New Investigator Award (Hamilton, Ontario, Canada). Dr. Devereaux has received a grant-in-kind from Roche Diagnostics (Mannheim, Germany) to evaluate troponin T among patients undergoing noncardiac surgery. Dr. McQueen has received grants-in-kind from Roche Diagnostics for evaluating diabetes, cardiac, and renal biomarkers in several clinical studies.