Prospective, Comprehensive Assessment of Cardiac Troponin T Testing After Coronary Artery Bypass Graft Surgery

Abstract

Background-The significance and clinical role of cardiac troponin testing after coronary artery bypass grafting remain unclear. Methods and Results-Cardiac troponin T (cTnT) was measured during the first 24 hours after coronary artery bypass graft surgery in 847 consecutive patients. Only 17 patients (2.0%) had new Q waves or left bundle-branch block after surgery; however, cTnT elevation was observed in nearly all subjects, with a median cTnT concentration of 1.08 ng/mL overall.

Diagnosis of MI after CABG with high-sensitivity troponin T and new ECG or echocardiogram changes: relationship with mortality and validation of the Universal Definition of MI

“…3,7 A potential reason for our finding of a lower area under the ROC curve may be that the superior sensitivity of the hs-TnT assay may have compromised its specificity and positive predictive value…”

“…2,3 Several studies have found that isolated troponin rise after CABG, measured with contemporary assays, independently predicts adverse outcomes. [3][4][5][6][7] High-sensitivity troponin assays have recently been developed, 8 being more sensitive than contemporary assays at detecting lower troponin levels. 1,9 The properties and utility of these assay may be different after CABG, and…”

Effect of remote ischemic preconditioning on clinical outcomes in patients undergoing coronary artery bypass graft surgery (ERICCA): rationale and study design of a multi-centre randomized double-blinded controlled clinical trial

“…Surgery in these patients is associated with an elevated overall operative risk of 5-6% compared to 1% in lower-risk patients [2], as well as an increased risk of periprocedural myocardial injury (as measured by serum CK-MB, Troponin T or I) [3], acute kidney injury (AKI) [4] and stroke [5], the presence of which are associated with worse clinical outcomes [6][7][8][9][10][11][12][13][14][15][16]. Myocardial injury during CABG surgery may be attributed to different mechanisms, including most importantly acute myocardial ischemiareperfusion injury (IRI), but also inflammatory response to the extraneous substances in the cardiopulmonary bypass circuit, left ventricular over-distension, coronary atheroembolism [17], increased cardiac workload during the intraoperative period, and direct myocardial injury due to retraction and handling of the heart [18].…”

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) .…”

“…O fato provoca ampla variação nos valores de pico médios de troponinas e que, frequentemente, estão acima de 10 vezes o percentil 99 (83) . Essa variabilidade prejudica a interpretação dos resultados e aumenta erroneamente o número de pacientes com diagnóstico de infarto tipo 5.…”