Comparison of High‐Sensitivity Troponin T Versus N‐Terminal Pro‐B‐Type Natriuretic Peptide for Prediction of Major Adverse Cardiovascular Events After Noncardiac Surgery
7 affiliations
- 1Department of Anaesthesiology Medical Faculty and University Hospital Düsseldorf, Heinrich‐Heine‐University Düsseldorf Düsseldorf Germany
- 2Department of Anaesthesiology Heidelberg University Hospital Heidelberg Germany
- 3Department of Anaesthesiology University Hospital Rheinisch–Westfaelische Technische Hochschule (RWTH) Aachen Aachen Germany
- 4Department of Anaesthesiology and Intensive Care Medicine Hannover Medical School Hannover Germany
- 5Deparment of Anaesthesiology University Medical Center Utrecht Utrecht The Netherlands
- 6Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences Linköping University Linköping Sweden
- 7Department of Perioperative Medicine and Intensive Care, Division of Anaesthesiology and Intensive Care, CLINTEC Karolinska Institute Stockholm Sweden
Abstract
Background: Preoperative hs‐TnT (high‐sensitivity cardiac troponin T) and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) are used for risk prediction in noncardiac surgery. While the European Society of Cardiology recommends hs‐TnT, American Cardiology and European anesthesiology societies support NT‐proBNP. Direct comparisons of their predictive performance are limited. This study compares preoperative hs‐TnT and NT‐proBNP in predicting cardiac events after noncardiac surgery.
Methods: This secondary analysis pooled data from the METREPAIR (Metabolic Equivalents: Reevaluation for Perioperative Cardiac Risk) and MINSS (Myocardial Injury in Noncardiac Surgery in Sweden) studies involving patients with elevated cardiovascular risk undergoing elective noncardiac surgery. The primary end point was the incidence of 30‐day major adverse cardiovascular events, with 30‐day death as the secondary end point. Logistic regression models, including Revised Cardiac Risk Index (RCRI) and age, were augmented by biomarkers. Prediction was assessed using area under the receiver operating characteristic curve, calibration slopes, and Brier scores. Decision curve analysis was conducted at predefined thresholds for major adverse cardiovascular events and death.
Results: Among 2251 patients, MACE occurred in 5.8% (131/2251) and death in 1.6% (37/2251). Both biomarkers were significantly associated with outcomes. Only hs‐TnT improved discrimination for predicting death (area under the receiver operating characteristic curveRCRI+age+hsTnT=0.680 versus area under the receiver operating characteristic curveRCRI+age=0.674; Δ area under the curve: 0.006; P=0.047). Brier scores and calibration slopes showed good calibration for all models. Benefit equivalents of RCRI+hs‐TnT versus RCRI+NT‐proBNP were −0.06 per 1000 and −0.17 per 1000 for major adverse cardiovascular events and +0.06 per 1000 versus –0.08 per 1000 (5% threshold) and −0.35 per 1000 versus –0.06 per 1000 (10% threshold) for death. A literature review did not suggest differences between biomarkers.
Conclusions: Hs‐TnT and NT‐proBNP were associated with major adverse cardiovascular events and death, but their contribution to risk prediction over RCRI and age was limited. No significant difference was found between biomarkers.
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BibTeX
@article{kirkopoulos2026comparison,
title = {{Comparison of High‐Sensitivity Troponin T Versus N‐Terminal Pro‐B‐Type Natriuretic Peptide for Prediction of Major Adverse Cardiovascular Events After Noncardiac Surgery}},
author = {Anna Kirkopoulos and Jan Larmann and Hans‐Joerg Gillmann and René M'Pembele and Vlad‐Ionut Bucur‐Cristescu and Theresa Tenge and Judith van Waes and Sebastian Roth and Alexandra Stroda‐Hartmann and Henrik Andersson and Helen Didriksson and Carina Jonsson and Michelle S. Chew and Giovanna A. Lurati Buse},
journal = {Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease},
year = {2026},
month = sep,
doi = {10.1161/jaha.126.050032},
url = {https://doi.org/10.1161/jaha.126.050032},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Comparison of High‐Sensitivity Troponin T Versus N‐Terminal Pro‐B‐Type Natriuretic Peptide for Prediction of Major Adverse Cardiovascular Events After Noncardiac Surgery
AU - Anna Kirkopoulos
AU - Jan Larmann
AU - Hans‐Joerg Gillmann
AU - René M'Pembele
AU - Vlad‐Ionut Bucur‐Cristescu
AU - Theresa Tenge
AU - Judith van Waes
AU - Sebastian Roth
AU - Alexandra Stroda‐Hartmann
AU - Henrik Andersson
AU - Helen Didriksson
AU - Carina Jonsson
AU - Michelle S. Chew
AU - Giovanna A. Lurati Buse
PY - 2026
DA - 2026/09/09
JO - Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
DO - 10.1161/jaha.126.050032
UR - https://doi.org/10.1161/jaha.126.050032
AB - Background: Preoperative hs‐TnT (high‐sensitivity cardiac troponin T) and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) are used for risk prediction in noncardiac surgery. While the European Society of Cardiology recommends hs‐TnT, American Cardiology and European anesthesiology societies support NT‐proBNP. Direct comparisons of their predictive performance are limited. This study compares preoperative hs‐TnT and NT‐proBNP in predicting cardiac events after noncardiac surgery. Methods: This secondary analysis pooled data from the METREPAIR (Metabolic Equivalents: Reevaluation for Perioperative Cardiac Risk) and MINSS (Myocardial Injury in Noncardiac Surgery in Sweden) studies involving patients with elevated cardiovascular risk undergoing elective noncardiac surgery. The primary end point was the incidence of 30‐day major adverse cardiovascular events, with 30‐day death as the secondary end point. Logistic regression models, including Revised Cardiac Risk Index (RCRI) and age, were augmented by biomarkers. Prediction was assessed using area under the receiver operating characteristic curve, calibration slopes, and Brier scores. Decision curve analysis was conducted at predefined thresholds for major adverse cardiovascular events and death. Results: Among 2251 patients, MACE occurred in 5.8% (131/2251) and death in 1.6% (37/2251). Both biomarkers were significantly associated with outcomes. Only hs‐TnT improved discrimination for predicting death (area under the receiver operating characteristic curveRCRI+age+hsTnT=0.680 versus area under the receiver operating characteristic curveRCRI+age=0.674; Δ area under the curve: 0.006; P=0.047). Brier scores and calibration slopes showed good calibration for all models. Benefit equivalents of RCRI+hs‐TnT versus RCRI+NT‐proBNP were −0.06 per 1000 and −0.17 per 1000 for major adverse cardiovascular events and +0.06 per 1000 versus –0.08 per 1000 (5% threshold) and −0.35 per 1000 versus –0.06 per 1000 (10% threshold) for death. A literature review did not suggest differences between biomarkers. Conclusions: Hs‐TnT and NT‐proBNP were associated with major adverse cardiovascular events and death, but their contribution to risk prediction over RCRI and age was limited. No significant difference was found between biomarkers.
SN - 2047-9980
ER -