{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:38:49Z","timestamp":1787859529220,"version":"build-2784847793"},"reference-count":41,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI20\/00154"],"award-info":[{"award-number":["PI20\/00154"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,20]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"\n Background<\/jats:title>\n Perioperative myocardial injury (PMI) is a common complication following non-cardiac, particularly thoracic, surgery and is associated with increased cardiovascular risk. Although guidelines recommend cardiac biomarker monitoring to detect PMI, its implementation in routine clinical practice remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the combined use of high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting major adverse cardiovascular events (MACE) following elective thoracic surgery, and to determine whether NT-proBNP provides incremental prognostic value beyond hs-cTnI alone.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Multicentre observational cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Conducted between February 2021 and November 2023 in three Spanish tertiary hospitals.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Patients aged \u226545 years scheduled for elective thoracic surgery involving lung resection (pneumonectomy, lobectomy, bilobectomy or segmentectomy) under general anaesthesia. Exclusion criteria included urgent or non-thoracic surgery, active infection or sepsis and a history of severe heart failure (ejection fraction <30%).<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Combined measurement of hs-cTnI and NT-proBNP at baseline (preoperatively) and at 24 and 48 hours postoperatively.<\/jats:p>\n PMI was defined as hs-cTnI \u226545 ng\/L at 24 and\/or 48 hours or a \u226520% increase from baseline in patients with elevated preoperative concentrations.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 475 patients, PMI occurred in 11.8%. PMI had higher rates of prior stroke (12.5% vs 2.9%; p=0.004), smoking history (85.7% vs 64.0%; p=0.001) and severe renal dysfunction (7.1% vs 0.7%; p=0.001), with similar Revised Cardiac Risk Index distribution. Patients with PMI also had greater postoperative elevations of hs-cTnI and NT-proBNP (p<0.001), longer surgeries (3.5 hours vs 2.7\u2009hours; p<0.001) and more frequent lobectomy\/bilobectomy (64.3% vs 50.4%; p<0.001). Robotic-assisted thoracic surgery (RATS) was associated with increased PMI risk (OR 2.29; p=0.019). Among 49 patients (10.3%) with dual postoperative elevation of hs-cTnI and NT-proBNP, cardiovascular comorbidities were common (hypertension 81.6%, smoking history 85.7%, stroke 14.3%), and most procedures were minimally invasive (video-assisted thoracic surgery 61.2%, RATS 24.5%), with a median duration of 3\u2009hours 42\u2009min. MACE occurred in 18.4% of this group, indicating a substantially elevated risk than isolated or no biomarker elevations. At 30 days, patients with PMI had higher MACE (14.3% vs 3.3%; p<0.001), mortality (3.6% vs 0.7%; p=0.049) and new-onset arrhythmias (5.3% vs 0.2%; p<0.001), particularly atrial fibrillation (7.1% vs 1.7%; p=0.011). Dual biomarker elevation was associated with the highest MACE risk (15.2%), representing a twofold to threefold increase over single biomarkers.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Combined hs-cTnI and NT-proBNP assessment improves perioperative cardiovascular risk stratification beyond ischaemia.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT04749212<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108073","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T14:25:35Z","timestamp":1776435935000},"page":"e108073","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["N-terminal proBNP adds prognostic value to high-sensitivity cardiac troponin I in elective thoracic surgery: an observational cohort study"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct04749212","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct04749212","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Mar\u00eda","family":"Alonso","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Hospital Vall d\u2019Hebron, Barcelona, Spain"},{"name":"Faculty of Medicine, Department of Surgery and Morphological Sciences, Universitat Aut\u00f2noma de Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-9873","authenticated-orcid":false,"given":"Ekaterine","family":"Popova","sequence":"additional","affiliation":[{"name":"Institut de Recerca Sant Pau, Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"De Miguel","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Hospital Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1lvaro","family":"Garc\u00eda-Osuna","sequence":"additional","affiliation":[{"name":"Institut de Recerca Sant Pau, Barcelona, Spain"},{"name":"Department of Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6509-6777","authenticated-orcid":false,"given":"Anna","family":"Gonzalez-Tallada","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Hospital Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Ordo\u00f1ez-Llanos","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"},{"name":"Foundation for Clinical Biochemistry & Molecular Pathology, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Jauregui","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery and Lung Transplantation, Hospital Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Trujillo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ascensi\u00f3n","family":"Martin Grande","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Hospital Universitario Ram\u00f3n y Cajal, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Mart\u00ednez-T\u00e9llez","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Parera","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina","family":"Planas","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Trujillo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health, Hospital de la Santa Creu 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