Troponin Levels and Mortality After Noncardiac Surgery

To the Editor: The VISION study¹ was conducted in a cohort of patients undergoing noncardiac surgery. Applying these results to an individual patient presenting for a specific procedure is difficult. Perioperative risk stratification should focus instead on individual procedures.² There may be particular benefits to monitoring troponin following specific types of surgery. For example, distinguishing risk in patients undergoing aortic abdominal aneurysm surgery is difficult due to the high surgical risk and a patient's widespread vascular disease.² In the VISION study, troponin elevation appeared to account for a large proportion of the perioperative risk in vascular surgical patients because surgical risk disappeared with adjustment for troponin levels. Therefore, troponin measurement may prove useful in this population.³ Intervention studies are needed in vascular surgery to determine if perioperative risk can be reduced through prevention or treatment of myocardial injury. It is also important to analyze the importance of troponin in lower risk surgery in which it may show less utility in predicting risk because mortality and myocardial injury are less frequent. In these cohorts, monitoring troponin may prove not to be cost-effective, given the large numbers of patients that may need to be screened.