McMaster researchers want Hamilton hospitals and doctors to use a simple blood test that identifies which patients are most likely to die after major surgery.
Right now, doctors don’t measure Troponin T — a complex of three proteins that’s integral to muscle contraction in skeletal and cardiac muscle — in the first three days after surgery to determine heart injury. But the researchers want that changed after their study, published in the Journal of the American Medical Association Tuesday, found it predicts which patients will die in the next 30 days.
“We’re going to push this to become the standard of care,” said Dr. P.J. Devereaux, lead investigator of the VISION study, McMaster University associate professor and cardiologist at Hamilton Health Sciences. “We owe that to patients.”
He will be advocating for hospitals to make it policy to use the test, but in the meantime he’s urging doctors to take matters into their own hands.
“Surgeons can order it themselves,” he said.
The chief of surgery at HHS said more research needs to be done, particularly on what treatment to give patients identified as being at risk, before it’s likely to be widely used.
“There’s several issues left to be understood,” said Dr. Wes Stephen. “There are lots of questions that would come up.”
However, he thinks the test has great potential to save lives.
“This is exciting because we’ve never had a test like this before,” he said. “If we identify the patients right after the operation, we can intervene and change the outcome. It has great promise to change mortality after major surgery.”
The blood test is important because previous studies have found patients don’t show symptoms that their hearts have been damaged in the days following an operation, making it hard to identify who is at risk of dying and needs treatment.
“Heart injury profoundly differentiates who is about to die,” said Devereaux. “Tragically, some are suffering injuries and we don’t recognize it and don’t intervene. The good news is we have been able to identify a test that strongly differentiates who is likely to die after surgery.”
The test works for all kinds of operations — except for heart surgery, because cardiac patients all have heart injury.
It was tested on 15,133 adult patients in North and South America, Asia, Australia and Europe. The research had more than 60 international funding sources including the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Ontario.
“This study has substantial potential to change how patients are monitored after surgery,” Dr. Jean Rouleau, scientific director of the Institute for Circulatory and Respiratory Health of the Canadian Institutes of Health Research, said in a statement.
“These results hold substantial promise that through measuring Troponin blood tests after surgery, physicians can identify which patients are at high-risk of dying and this can allow them to consider enhanced monitoring and interventions in an attempt to improve outcomes. This is a good example of how a carefully conducted clinical study can impact on patient care.”
Next, the researchers plan to study whether treating the identified patients with Aspirin, statins or a new blood thinner called Pradax (also known as dabigatran etexilate) can save their lives.
“We did identify there is time to intervene,” said Devereaux. “Our hope is that we can start changing the outcomes.”