The prognostic value of troponin release after adult cardiac surgery — a meta-analysis

Abstract

To assess the accuracy of increased troponin (Tn) concentrations for the prediction of mid-term (> or = 12 months) mortality after coronary artery bypass graft (CABG) and valve surgery, we performed a systematic review identifying all studies reporting on the association between postoperative troponin release and mortality after cardiac surgery. Studies were identified through 30 April 2008 by electronic searches of the MEDLINE, EMBASE and BIOSIS databases. Two reviewers independently selected studies, assessed methodological quality and extracted the data. We primarily considered mid-term (> or = 12 months) and secondarily short-term (< or = 30 days) all-cause mortality. A bivariate random-effects model was used to study determinants and to pool measures of prognostic accuracy of Tn. Seventeen studies fulfilled the inclusion criteria with a total of 237 mid-term deaths in 5189 patients and 296 short-term deaths in 9703 patients. The diagnostic odds ratio of increased Tn concentrations was 5.46 (95% confidence interval (CI) 2.0-14.6) for mid-term mortality and 6.57 (95% CI 4.3-10.1) for short-term mortality after adult cardiac surgery. Alternatively expressed, for troponin elevation, the sensitivity was 0.45 (0.26-0.67) and the specificity 0.87 (0.73-0.90) to predict mid-term mortality. The sensitivity was 0.59 (0.48-0.69) and the specificity 0.82 (0.72-0.89) for short-term mortality. Between-study variability was high. In conclusion, this meta-analysis provides evidence for an association between postoperative Tn release with mid- and short-term all-cause mortality after adult cardiac surgery. However, differences in populations, timing of Tn testing, Tn subunit and Tn assays make definitive conclusions about effect size and cut-off values difficult.

Myocardial protection with prophylactic oral metoprolol during coronary artery bypass grafting surgery: evaluation by troponin I

“…However, the higher the value for a cardiac biochemical marker after the procedure, the greater the myocardial injury, regardless of the mechanism of injury. Despite the difficulties in interpreting the troponin level after a CABG, it is known that the higher this value, the worse the prognosis [ 7 , 8 ] .…”

Combination of EuroSCORE and Cardiac Troponin I Improves the Prediction of Adverse Outcome after Cardiac Surgery

“…6 Moreover, a single postoperative 24-h measurement reliably predicts in-hospital adverse outcome and can be recommended in clinical routine practice as an easy, objective, and cost-effective tool for the detection of high-risk patients. 18 Unfortunately, the accuracy of postoperative cTnI in predicting poor outcome may be different among cardiac surgical procedures (being less in valve than in coronary surgery), thereby necessitating to consider different thresholds for accurate identification of high-risk patients.…”

“…[3][4][5] A recent meta-analysis provided further evidence for a significant association between postoperative cTnI release and short-and long-term all-cause mortality after adult cardiac surgery. 6 However, the prognostic value of preoperative cTnI has only rarely been considered in the cardiac surgical setting. 7,8 The general criteria for clinically useful risk markers and the hierarchical steps in demonstrating the clinical interest of a biomarker have been recently published 9,10 and have served as a reminder that we should compare the diagnostic properties of the biomarker with existing predictive models of risk stratification and validate an incremental prognostic value before recommending wider use for routine practice.…”

Perioperative Myocardial Injury after Adult Heart Transplant: Determinants and Prognostic Value

“…Given the inherent high sensitivity and specificity for myocardial injury, the release of such biomarkers is a valuable tool to estimate both the burden of the surgical procedure and the underlying vulnerability of the myocardium. The evidence from a recent authoritative meta-analysis and several publications is that, despite a variety of confounding factors prevents definitive conclusion about effect size and cut-off value, such a release is a predictor of both early and midterm survival [ 1 – 3 ]. Unlike in non-transplantation settings, data regarding risk factors and consequences of troponin release after cardiac transplantation are less clear.…”