Early Troponin T and Prediction of Potentially Correctable In-Hospital Complications after Coronary Artery Bypass Grafting Surgery

Abstract

BackgroundPeak levels of troponin T (TnT) reliably predict morbidity and mortality after cardiac surgery. However, the therapeutic window to manage CABG-related in-hospital complications may close before the peak is reached. We investigated whether early TnT levels correlate as well with complications after coronary artery bypass grafting (CABG) surgery.MethodsA 12 month consecutive series of patients undergoing elective isolated CABG procedures (mini-extra-corporeal circuit, Cardioplegic arrest) was analyzed. Logistic regression modeling was used to investigate whether TnT levels 6 to 8 hours after surgery were independently associated with in-hospital complications (either post-operative myocardial infarction, stroke, new-onset renal insufficiency, intensive care unit (ICU) readmission, prolonged ICU stay (>48 hours), prolonged need for vasopressors (>24 hours), resuscitation or death).ResultsA total of 290 patients, including 36 patients with complications, was analyzed. Early TnT levels (odds ratio (OR): 6.8, 95% confidence interval (CI): 2.2-21.4, P=.001), logistic EuroSCORE (OR: 1.2, 95%CI: 1.0-1.3, P=.007) and the need for vasopressors during the first 6 postoperative hours (OR: 2.7, 95%CI: 1.0-7.1, P=.05) were independently associated with the risk of complications. With consideration of vasopressor use during the first 6 postoperative hours, the sum of specificity (0.958) and sensitivity (0.417) of TnT for subsequent complications was highest at a TnT cut-off value of 0.8 ng/mL.ConclusionEarly TnT levels may be useful to guide ICU management of CABG patients. They predict clinically relevant complications within a potential therapeutic window, particularly in patients requiring vasopressors during the first postoperative hours, although with only moderate sensitivity.

Prognostic Value of Early Postoperative Troponin T in Patients Undergoing Coronary Artery Bypass Grafting

“…In this prospective cohort study, we wanted to determine the association between cTnT levels measured 6 to 12 hours after CABG and in‐hospital outcome, validating our previous findings, including the prespecified cutoff of 800 ng/L, and further investigate the clinical utility of early cTnT.…”

“…The prespecified primary prognostic variable was cTnT, assessed between 6 and 12 hours postoperatively. The secondary prognostic variables were the logistic version of the European System for Cardiac Operative Risk Evaluation (subsequently referred to as EuroSCORE) and requirement for inotropes or vasopressors within 6 hours postoperatively, as previously reported . For each patient, we calculated the EuroSCORE, which predicts the risk of 30‐day all‐cause mortality from preoperative factors on the basis of a logistic regression model using age, sex, comorbid conditions, patient history, and left ventricular ejection fraction …”

“…The prespecified primary outcome was in‐hospital major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of death from any cause, MI, or stroke. The prespecified secondary outcome was a safety composite of MACCE, resuscitation, stay at the intensive care unit of >48 hours’ duration, readmission to the intensive care unit, need for inotropes or vasopressors for >24 hours, or new‐onset renal insufficiency, as previously reported for the analysis of the development cohort . The diagnosis of MI was based on signs or symptoms consistent with myocardial ischemia, ECG changes, and CK and CK‐MB (mass) levels, as specified by the Academic Research Consortium for the adjudication of events occurring after CABG .…”

“…In the second study, troponin T measured between 8 and 16 hours postoperatively had moderate to high discrimination (area under the curve, ≥0.73) for perioperative MI . The third study was a pilot study conducted by our group . Among 290 adults undergoing isolated CABG, we demonstrated that a cardiac troponin T (cTnT) increase of 1000 ng/L, measured at a mean 8.1 hours postoperatively, was associated with a 7‐fold increase in in‐hospital complications, including periprocedural MI, prolonged need for vasopressors, and new‐onset renal insufficiency.…”

Liberação de biomarcadores de necrose miocárdica após revascularização cirúrgica do miocárdio sem circulação extracorpórea, em ausência de infarto do miocárdio manifesto, avaliado pela ressonância magnética cardíaca

“…Inicialmente, a reprodutibilidade dos estudos é baixa em razão do reduzido número de indivíduos com seguimento a longo prazo e a utilização de desfechos compostos de menor relevância, como a necessidade de suporte ventilatório mecânico (83,87) . Não houve correlação evidente entre biomarcadores cardíacos com infarto do miocárdio documentado por autópsia, novo realce tardio em RMC com gadolínio ou aparecimento de nova onda Q ou BRE novo (88)(89)(90) .…”