Long-term Survival and Cardiac Troponin T Elevation in On- and Off-Pump Coronary Artery Bypass Surgery

Brown, Jeremiah R.; Hernandez, Felix; Klemperer, John D.; Clough, Robert A.; DiPierro, Francis V.; Hofmaster, Patricia; Ross, Cathy S.; O’Connor, Gerald T.

doi:10.1532/hsf98.20081017

Cited by 3 publications

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“…The relevance of troponin T on long-term outcome after cardiac surgery is not quite clear. Brown and colleagues could not associate troponin T levels after on- and off-pump coronary artery bypass with a prognostic value [ 36 ]. However recent studies and meta-analyses did associate high troponin T levels with poor long-term outcome after vascular surgery [ 37 ], after percutaneous coronary interventions [ 38 ], and after cardiac transplantation [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Late Post-Conditioning with Sevoflurane after Cardiac Surgery - Are Surrogate Markers Associated with Clinical Outcome?

et al. 2015

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IntroductionIn a recent randomized controlled trial our group has demonstrated in 102 patients that late post-conditioning with sevoflurane performed in the intensive care unit after surgery involving extracorporeal circulation reduced damage to cardiomyocytes exposed to ischemia reperfusion injury. On the first post-operative day the sevoflurane patients presented with lower troponin T values when compared with those undergoing propofol sedation. In order to assess possible clinical relevant long-term implications in patients enrolled in this study, we performed the current retrospective analysis focusing on cardiac and non-cardiac events during the first 6 months after surgery.MethodsAll patients who had successfully completed the late post-conditioning trial were included into this follow-up. Our primary and secondary endpoints were the proportion of patients experiencing cardiac and non-cardiac events, respectively. Additionally, we were interested in assessing therapeutic interventions such as initiation or change of drug therapy, interventional treatment or surgery.ResultsOf 102 patients analyzed in the primary study 94 could be included in this follow-up. In the sevoflurane group (with 41 patients) 16 (39%) experienced one or several cardiac events within 6 months after cardiac surgery, in the propofol group (with 53 patients) 19 (36%, p=0.75). Four patients (9%) with sevoflurane vs. 7 (13%) with propofol sedation had non-cardiac events (p=0.61). While a similar percentage of patients suffered from cardiac and/or non-cardiac events, only 12 patients in the sevoflurane group compared to 20 propofol patients needed a therapeutic intervention (OR: 0.24, 95% CI: 0.04-1.43, p=0.12). A similar result was found for hospital admissions: 2 patients in the sevoflurane group had to be re-admitted to the hospital compared to 8 in the propofol group (OR 0.23, 95% CI: 0.04-1.29, p=0.10).ConclusionsSevoflurane does not seem to provide protection with regard to the occurrence of cardiac and non-cardiac events in the 6-month period following cardiac surgery with the use of extracorporeal circulation. However, there was a clear trend towards fewer interventions (less need for treatment, fewer hospital admissions) associated with sevoflurane post-conditioning in patients experiencing any event. Such results might encourage launching large multicenter post-conditioning trials with clinical outcome defined as primary endpoint.

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Section: Discussionmentioning

confidence: 99%

Late Post-Conditioning with Sevoflurane after Cardiac Surgery - Are Surrogate Markers Associated with Clinical Outcome?

et al. 2015

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Off-Pump Versus On-Pump Coronary Revascularization: Meta-Analysis of Mid- and Long-Term Outcomes

Chaudhry

Harling

Rao

et al. 2014

The Annals of Thoracic Surgery

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Worse long-term survival after off-pump than on-pump coronary artery bypass grafting

Takagi

Umemoto

2014

The Journal of Thoracic and Cardiovascular Surgery

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Long-term Survival and Cardiac Troponin T Elevation in On- and Off-Pump Coronary Artery Bypass Surgery

Abstract: Survival is better for CCAB patients than for OPCAB patients, regardless of cTnT concentration. This effect is sustained after multivariable adjustment for baseline mortality risk factors.

Cited by 3 publications

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Late Post-Conditioning with Sevoflurane after Cardiac Surgery - Are Surrogate Markers Associated with Clinical Outcome?

Late Post-Conditioning with Sevoflurane after Cardiac Surgery - Are Surrogate Markers Associated with Clinical Outcome?

Off-Pump Versus On-Pump Coronary Revascularization: Meta-Analysis of Mid- and Long-Term Outcomes

Worse long-term survival after off-pump than on-pump coronary artery bypass grafting

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