***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Of the 200 million adults worldwide who undergo noncardiac surgery each year , more than 1 million will die within 30 days . OBJECTIVE To determine the relationship between the peak fourth-generation troponin T ( TnT ) measurement in the first 3 days after noncardiac surgery and 30-day mortality . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve , international cohort study that enrolled patients from August 6 , 2007 , to January 11 , 2011 . Eligible patients were aged 45 years and older and required at least an overnight hospital admission after having noncardiac surgery . MAIN OUTCOME MEASURES Patients ' TnT levels were measured 6 to 12 hours after surgery and on days 1 , 2 , and 3 after surgery . We undertook Cox regression analysis in which the dependent variable was mortality until 30 days after surgery , and the independent variables included 24 preoperative variables . We repeated this analysis , adding the peak TnT measurement during the first 3 postoperative days as an independent variable and used a minimum P value approach to determine if there were TnT thresholds that independently altered patients ' risk of death . RESULTS A total of 15,133 patients were included in this study . The 30-day mortality rate was 1.9 % ( 95 % CI , 1.7%-2.1 % ) . Multivariable analysis demonstrated that peak TnT values of at least 0.02 ng/mL , occurring in 11.6 % of patients , were associated with higher 30-day mortality compared with the reference group ( peak TnT ≤ 0.01 ng/mL ) : peak TnT of 0.02 ng/mL ( adjusted hazard ratio [ aHR ] , 2.41 ; 95 % CI , 1.33 - 3.77 ) ; 0.03 to 0.29 ng/mL ( aHR , 5.00 ; 95 % CI , 3.72 - 6.76 ) ; and 0.30 ng/mL or greater ( aHR , 10.48 ; 95 % CI , 6.25 - 16.62 ) . Patients with a peak TnT value of 0.01 ng/mL or less , 0.02 , 0.03 - 0.29 , and 0.30 or greater had 30-day mortality rates of 1.0 % , 4.0 % , 9.3 % , and 16.9 % , respectively . Peak TnT measurement added incremental prognostic value to discriminate those likely to die within 30 days for the model with peak TnT measurement vs without ( C index = 0.85 vs 0.81 ; difference , 0.4 ; 95 % CI , 0.2 - 0.5 ; P < .001 for difference between C index values ) . The net reclassification improvement with TnT was 25.0 % ( P < .001 ) . CONCLUSION Among patients undergoing noncardiac surgery , the peak postoperative TnT measurement during the first 3 days after surgery was significantly associated with 30-day mortality BACKGROUND Cardiac complications are important causes of morbidity after noncardiac surgery . The purpose of this prospect i ve cohort study was to develop and vali date an index for risk of cardiac complications . METHODS AND RESULTS We studied 4315 patients aged > or = 50 years undergoing elective major noncardiac procedures in a tertiary-care teaching hospital . The main outcome measures were major cardiac complications . Major cardiac complications occurred in 56 ( 2 % ) of 2893 patients assigned to the derivation cohort . Six independent predictors of complications were identified and included in a Revised Cardiac Risk Index : high-risk type of surgery , history of ischemic heart disease , history of congestive heart failure , history of cerebrovascular disease , preoperative treatment with insulin , and preoperative serum creatinine > 2.0 mg/dL. Rates of major cardiac complication with 0 , 1 , 2 , or > or = 3 of these factors were 0.5 % , 1.3 % , 4 % , and 9 % , respectively , in the derivation cohort and 0.4 % , 0.9 % , 7 % , and 11 % , respectively , among 1422 patients in the validation cohort . Receiver operating characteristic curve analysis in the validation cohort indicated that the diagnostic performance of the Revised Cardiac Risk Index was superior to other published risk-prediction indexes . CONCLUSIONS In stable patients undergoing nonurgent major noncardiac surgery , this index can identify patients at higher risk for complications . This index may be useful for identification of c and i date s for further risk stratification with noninvasive technologies or other management strategies , as well as low-risk patients in whom additional evaluation is unlikely to be helpful OBJECTIVES To determine if troponin I and NT-proBNP were predictors of 6-month mortality after emergency  orthopedic-geriatric surgery in a frail population . DESIGN Prospect i ve observational study . SETTING Orthopedic-geriatric unit of a metropolitan hospital in Australia . PARTICIPANTS A total of 383 patients were screened ; 44 were eligible for this study of which 33 patients consented who were receiving high-level care or had severe dementia or an illness with a prognosis of less than 12 months . MEASUREMENTS  Troponin I and NT-proBNP  were tested on one preoperative sample and at least one postoperative blood sample . Cardiac events were defined as acute myocardial infa rct ion , congestive cardiac failure , new onset or rapid atrial fibrillation , major arrhythmia , or cardiac arrest . RESULTS The mean age of the patients was 85.8 + /- 9.6 years and 93.9 % had a fractured neck of femur .  Premorbid cardiac conditions were common ( 24.2 % had ischemic heart disease and 21.2 % congestive cardiac failure ) . A third of patients had a preoperative troponin elevation and 60.6 % had a postoperative elevation . The mortality within 30 days of surgery was 15.2 % ( 5/33 patients ) , rising to 39.4 % ( 13/33 ) at 6 months with 46.2 % ( 6/13 ) dying of a cardiac cause . The Kaplan-Meier survival curve was not significantly different between patients with and without a troponin elevation . A third of patients sustained a cardiac event at 6 months . The median preoperative NT-proBNP was 1651.50 pg/L , range 25 to 31,227 , and median postoperative NT-proBNP was 3038.50pg/L , range 44 to 27,348 . Troponin I and NT pro-BNP did not predict 6-month mortality or cardiac complications . Predictors of 6-month mortality using univariate analysis were number of comorbidities OR 2.0 ( 95 % CI 1.1 - 3.8 , P = .033 ) and premorbid atrial fibrillation OR 7.7 ( 95 % CI 1.2 - 47.8 , P = .028 ) . CONCLUSION Troponin I and NT-proBNP were not predictors of 6-month mortality or cardiac events in an older frailer population of patients undergoing orthopedic surgery .  These patients sustained substantial cardiac morbidity and mortality at 6 months after surgery . The control of symptoms , rather than prolongation of life with cardiological intervention , may be more appropriate for this patient group : The purpose of this up date of the European Society of Anaesthesiology ( ESA ) guidelines on the pre-operative evaluation of the adult undergoing noncardiac surgery is to present recommendations based on the available relevant clinical evidence . Well performed r and omised studies on the topic are limited and therefore many recommendations rely to a large extent on expert opinion and may need to be adapted specifically to the healthcare systems of individual countries . This article aims to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthesiologists all over Europe to integrate - wherever possible - this knowledge into daily patient care . The Guidelines Committee of the ESA formed a task force comprising members of the previous task force , members of ESA scientific subcommittees and an open call for volunteers was made to all individual active members of the ESA and national societies . Electronic data bases were search ed from July 2010 ( end of the literature search of the previous ESA guidelines on pre-operative evaluation ) to May 2016 without language restrictions . A total of 34 066 abtracts were screened from which 2536 were included for further analysis . Relevant systematic review s with meta-analyses , r and omised controlled trials , cohort studies , case-control studies and cross-sectional surveys were selected . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) system was used to assess the level of evidence and to grade recommendations . The final draft guideline was posted on the ESA website for 4 weeks and the link was sent to all ESA members , individual or national ( thus including most European national anaesthesia societies ) . Comments were collated and the guidelines amended as appropriate . When the final draft was complete , the Guidelines Committee and ESA Board ratified the guidelines INTRODUCTION The relationship between  electrocardiograph ( ECG )  changes and troponin levels after the emergency orthopaedic surgery are not well characterised . The aim of this study was to determine the correlation between ECG changes ( ischaemia or arrhythmia ) , troponin elevations perioperatively and cardiac complications . MATERIAL S AND METHODS One hundred and eighty-seven orthopaedic patients over 60 years of age were prospect ively tested for troponin I and ECGs were performed on the fi rst 3 postoperative mornings or until discharge . RESULTS The incidences of pre- and postoperative troponin elevation were 15.5 % and 37.4 % respectively , the majority were asymptomatically detected . Most of the patients who sustained a troponin rise did not have any concomitant ECG changes ( 51/70 or 72.9 % ) . Postoperative ECG changes were noted in 18.4 % ( 34/185 ) and of those with ECG changes , slightly more than half ( 55.9 % ) had a troponin elevation . Most ECG changes occurred on postoperative day 1 and were non-ST elevation in type . ECG changes occurred more frequently with higher troponin levels . Postoperative troponin elevation ( P = 0.018 ) and not preoperative troponin level ( P = 0.060 ) was associated with ECG changes on univariate analysis . Two premorbid factors were predictors of postoperative ECG changes using multivariate logistical regression ; age [ odds ratio ( OR ) , 1.05 ; 95 % CI , 1.005 to 1.100 , P = 0.029 ) and sex OR , 2.4 ; 95 % CI , 1.069 to 5.446 , P = 0.034 ) . Twenty patients sustained postoperative cardiac complications ; 9 ( 45 % ) were associated with ECG changes and 16 ( 80 % ) with postoperative troponin elevation . Pre- or postoperative troponin elevation better predicted cardiac complications compared with preoperative ECG changes . CONCLUSION Electrocardiograph changes do not necessarily accompany troponin elevations after the emergency orthopaedic surgery but are more likely to have higher troponin levels . The best predictor of postoperative cardiac complications is troponin elevation AIMS We aim ed to evaluate the incremental value of high-sensitive troponin T ( hsTnT ) for risk prediction prior to non-cardiac surgery in comparison with the established revised cardiac index . METHODS AND RESULTS In this prospect i ve , international multicentre observational study , 979 patients prior to non-cardiac surgery were enrolled . The endpoints were in-hospital mortality , the combination of death , acute myocardial infa rct ion , cardiac arrest , cardio-pulmonary resuscitation , and acute decompensated heart failure . Twenty-five patients ( 2.6 % ) deceased and 36 ( 3.7 % ) of the patients experienced the combined endpoint . Cardiac markers were elevated in those patients who died when compared with survivors ( hsTnT : 21 ng/L vs. 7 ng/L ; P < 0.001 ; NT-proBNP : 576 pg/mL vs. 166 pg/mL ; P < 0.001 ) . Applying a cut-off for hsTnT of 14 ng/L and for NT-proBNP of 300 pg/mL , those patients with elevated hsTnT had a mortality of 6.9 vs. 1.2 % ( P < 0.001 ) and with elevated NT-proBNP 4.8 vs. 1.4 % ( P = 0.002 ) . The highest AUC of the ROC curve was found for hsTnT as a predictor for mortality of 0.809 . In a multivariate Cox regression analyses , hsTnT was the strongest independent predictor for the combined endpoint [ HR 2.6 ( 95 % CI : 1.3 - 5.3 ) ; P = 0.01 ] . CONCLUSION High-sensitive troponin T provides strong prognostic information in patients undergoing non-cardiac surgery incremental to the widely accepted revised cardiac 
    Output:
    
Our study indicates that although preoperative cTn and perioperative change in cTn might be valuable predictors of MACE and /or all-cause mortality in adult noncardiac surgical patients , its overall prognostic performance remains uncertain .