Role of high-sensitivity cardiac troponin in the early accurate diagnosis of peri-operative acute myocardial infarction

Background: Clinical assessment of myocardial ischemia risk and early rapid and accurate diagnosis of acute myocardial infarction (AMI) are lacking. Methods: Surgical patients with coronary heart disease (CHD) or its risk factors were recruited. According to the perioperative chest pain, severe myocardial ischemia related changes in ECG, and vital signs, blood samples were collected at different time points for the detection of hs-cTnT and cTnT. Results: The hs-cTnT area under receiver operating curve (AUC) of all patients with postoperative chest pain or severe myocardial ischemia within 3 h and 6 h was 0.902 and 0.941, respectively, diagnostic accuracy for AMI was 86.3% and 92.6%, respectively, sensitivity was 89.1% and 93.8%, respectively, and specificity was 83.5% and 92.5%, respectively. The cTnT AUC within 3 h and 6 h was 0.623 and 0.820, respectively, diagnostic accuracy for AMI was 38.5% and 85.0%, respectively, sensitivity was 32.6% and 81.0%, respectively, and specificity was 37.8% and 83.8%, respectively. Postoperative incidence of AMI in patients with CHD was significantly higher than in other patients. At 3 h and 6 h after chest pain, hs-cTnT concentration higher than 99th percentile of healthy controls was observed in 77.4% and 89.6% of high risk patients, respectively, and >20% change in plasma hs-cTnT was found in 51.2% and 82.5% of high risk patients, respectively. Conclusion: Patients with high risk had higher hs-cTnT than other groups. Continuous peri-operative detection of hs-cTnT is able to assess the risk for myocardial ischemic injury and help the early accurate diagnosis of AMI. It is especially important for patients with clinically invisible chest pain.