Clinical Relevance of Troponin T Profile Following Cardiac Surgery

Abstract

Background: Peak post-operative cardiac troponin T (cTnT) independently predicts mid- and long-term outcome of cardiac surgery patients. A few studies however have reported two peaks of cTnT over the first 48–72 h following myocardial reperfusion. The aim of the current study was to better understand underlying reasons of these different cTnT profiles and their possible relevance in terms of clinical outcome.Methods: All consecutive adult cardiac surgical procedures performed with an extra-corporeal circulation during a >6 years period were retrospectively evaluated. Patients with a myocardial infarction (MI) < 8 days were excluded. cTnT profile of patients with at least one value ≥1 ng/mL value were categorized according to the time occurrence of the peak value. Univariable and multivariable analysis were performed to identify factors influencing early vs. late increase of cTnT values, and to verify the correlation of early vs. late increase with clinical outcome.Results: Data of 5,146 patients were retrieved from our prospectively managed registry. From 953 with at least one cTnT value ≥1 ng/mL, peak occurred ≤ 6 h (n = 22), >6 to ≤ 12 h (n = 366), >12 to ≤ 18 h (n = 176), >18 to ≤ 24 h (171), >24 h (218). Age (OR: 1.023; CI: 1.016–1.030) and isolated CABG (OR: 1.779; CI: 1.114–2.839) were independent predictors of a late increase of cTnT over a limit of 1 ng/ml (p < 0.05), whereas isolated valve procedures (OR: 0.685; CI: 0.471–0.998) and cross-clamp duration (OR: 0.993; CI: 0.990–0.997) independently predicted an early elevation (p < 0.05). Delayed elevation as opposed to early elevation correlated with a higher rate of post-operative complications including MI (19.8 vs. 7.2%), new renal insufficiency (16.3 vs. 6.7%), MACCE (32.0 vs. 15.5%), or death (7.4 vs. 4.4%).Conclusion: Profile of cTnT elevation following cardiac surgery depends on patients' intrinsic factors, type of surgery and duration of cross-clamp time. Delayed increase is of higher clinically relevance than prompt post-operative elevation.

Effects of peak time of myocardial injury biomarkers on mid-term outcomes of patients undergoing OPCABG

“…The proportion of patients whose CK-MB peaked within 24 h after operation was 67.73%. Patients with maximal peak values had a delayed increase time of peak occurrence, which is similar to another report [ 15 ].…”

“…Due to differences in assessment approaches, time and number of assessment, there is no unified understanding of this issue. Most literature involves only 2–3 measurements at certain time points after operation, including many types of cardiac surgeries and mixed postoperative death cases [ 2 – 5 , 7 , 15 – 17 ]. Those factors make it difficult to understand the profile of MIBs after surgical performances.…”

Detecting patients with PMI post-CABG based on cardiac troponin-T profiles: A latent class mixed modeling approach

“…The low profile class, which contains almost exclusively OPCAB surgeries, is in agreement with literature describing a delayed and lower peak for OPCAB surgery [10,11,13]. The rising profile class is also in agreement literature, describing a PMI profile as having a delayed peak or rise following an earlier peak [10,12,[14][15][16][17]. To explain the cTnT release profile of patients with PMI, most studies refer to the work from Katus et.…”

“…Several studies have focused on the release profile (or kinetics) of cTn post-CABG, arguing that insight in the normal postoperative release profile can aid clinicians in recognizing patients with PMI and that timing of the peak is relevant when applying cut-off values [10][11][12]. Aside from the normal post-operative CABG cTn release profile, studies describe profiles for off-pump CABG (OPCAB) surgery [10,11,13] and surgeries complicated by PMI [10][11][12][14][15][16][17]. While these studies demonstrate the variability in cTn release profiles and their value in recognizing PMI, they a priori define subgroups based on clinical characteristics or outcomes and subsequently evaluate cTn profiles.…”

Towards an improved definition of periprocedural myocardial infarction: The role of high‐sensitivity cardiac troponins

“…In the study by Niclauss et al, the incorporation of mitral valve surgery, where bicaval cannulation and atriotomy inherently result in myocardial damage, and septal myectomy, where the goal of the procedure is to induce myocardial damage, seem methodologically worrisome. Thereby, even in isolated CABG itself, important differences in the number of distal grafts (i.e., aortic cross‐clamping time), 9 , 10 use of different types of cardioplegia, 11 and use of cardiopulmonary bypass (i.e., OPCAB) exist. 12 Especially the use of OPCAB yields significantly lower biomarker concentrations due to the absence of cannulation and cardioplegic arrest, as confirmed in a recent meta‐analyis.…”