RT Journal
A1 Devereaux PJ, Chan MV, Alonso-Coello P, Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators o
T1 TRoponin levels and mortality after noncardiac surgery—reply
JF JAMA
JO JAMA
YR 2012
FD September 26
VO 308
IS 12
SP 1204
OP 1205
DO 10.1001/2012.jama.11268
UL http://dx.doi.org/10.1001/2012.jama.11268
AB 
In the VISION Study, based on the center's determination of the cause of death, we demonstrated that troponin T levels after noncardiac surgery not only predicted vascular death but also predicted nonvascular death. Fujita points out that a patient with sepsis may experience a troponin elevation without compromise of coronary blood flow. Although this is true, this is unlikely to explain the troponin elevations in the VISION Study. In our study, the elevated troponin levels occurred days before patients developed sepsis; 74.2% of patients who developed an elevated troponin T level did so within the first 24 hours after surgery, whereas the median time to develop sepsis was 7 days after surgery. Sepsis is an independent predictor of mortality and requires aggressive treatment. However, the VISION data identified the possibility that interventions to manage myocardial injury that occurs prior to sepsis may decrease deaths classified as nonvascular.