Troponin after Cardiac Surgery: A Predictor or a Phenomenon?

Nesher, Nahum; Alghamdi, Abdullah A.; Singh, Steve K.; Sever, Jeri; Christakis, George T.; Goldman, Bernard S.; Cohen, Gideon; Moussa, Fuad; Fremes, Stephen E.

doi:10.1016/j.athoracsur.2007.12.077

Cited by 97 publications

(104 citation statements)

References 16 publications

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“…21, 22 Postoperative MI was defined as the occurrence of an increase in troponin-T ≥0.8 ng/ml and/or development of new pathologic Q wave on electrocardiogram. 23 Troponin-T was evaluated 1 day prior to surgery and at 12, 24, and 48 h after surgery. The length of stay in the ICU and general ward was also recorded.…”

Section: Methodsmentioning

confidence: 99%

Effect of Hydroxyethyl Starch 130/0.4 on Blood Loss and Coagulation in Patients With Recent Exposure to Dual Antiplatelet Therapy Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

Lee

Ahn

Song

et al. 2011

Circ J

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Background: Hydroxyethyl starch (HES) solutions are often used for maintaining intravascular volume and improving microperfusion, while a large amount of HES can cause adverse effects on coagulation. As the indications for clopidogrel expand, an increasing number of patients undergoing off-pump coronary artery bypass surgery (OPCAB) are also undergoing dual antiplatelet therapy (DAPT), with its higher risk of bleeding complications. The aim of the present study was to determine whether a moderate dose of 6% HES 130/0.4 significantly increases perioperative blood loss in patients with continued DAPT within 5 days of OPCAB. Methods and Results:Patients who received clopidogrel and aspirin within 5 days of OPCAB were randomly allocated to receive HES 130/0.4 (≤30 ml/kg) followed by crystalloid infusion (HES group, n=53), or crystalloid only (crystalloid group, n=53) perioperatively. The amount of perioperative blood loss (sum of bleeding during the intraoperative and postoperative 24-h period), transfusion requirements, modified thromboelastography and coagulation variables, hemodynamic parameters, and fluid balance were recorded. Perioperative blood loss and coagulation profiles were similar between the groups, but the postoperative hemoglobin level was higher in the crystalloid group.Conclusions: Up to 30 ml · kg -1 · day -1 of 6% HES 130/0.4 did not increase the perioperative blood loss compared to crystalloid in patients with recent exposure to DAPT undergoing OPCAB. HES 130/0.4 caused a similar degree and duration of coagulation impairment as observed when only crystalloid was given. (Circ J 2011; 75: 2397 - 2402

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Section: Methodsmentioning

confidence: 99%

Effect of Hydroxyethyl Starch 130/0.4 on Blood Loss and Coagulation in Patients With Recent Exposure to Dual Antiplatelet Therapy Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

Lee

Ahn

Song

et al. 2011

Circ J

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“…However, Minkin et al 22 and Stein et al 23 found that CTnI levels within 24 hours of ICU admission or peak levels during the ICU stay correlated poorly with hospital length of stay, readmission rates, and mortality at 6 months after discharge. The results of these 2 retrospective studies 22,23 suggest that CTnI level is a poor predictor for such outcomes in non-ACS patients and conflict with the findings of Garrett et al 16 Only 3 studies [18][19][20] were conducted prospectively and outside the United States, and none of the studies [15][16][17][18][19][20][21][22][23] included an evaluation of the prognostic value of CTnI levels in long-term care patients. As mentioned earlier, cardiovascular disease is the most common cause of death among long-term care residents.…”

mentioning

confidence: 42%

“…Previous investigations, [15][16][17][18][19][20][21] mostly retrospective observational studies, have indicated that serum levels of CTnI and/or troponin T subunits are reliable prognostic markers for multiple outcomes, including severity of traumatic brain injury as indicated by scores on the Glasgow Coma Scale, hospital mortality and length of stay, and ICU length of stay, among critically ill patients across different medical specialties, including cardiothoracic surgery, neurology, and general surgery (Table 1). However, Minkin et al 22 and Stein et al 23 found that CTnI levels within 24 hours of ICU admission or peak levels during the ICU stay correlated poorly with hospital length of stay, readmission rates, and mortality at 6 months after discharge.…”

mentioning

confidence: 99%

Prognostic Value of Initial Elevation in Cardiac Troponin I Level in Critically Ill Patients Without Acute Coronary Syndrome

Liu

Shehu

Herrold

et al. 2015

Critical Care Nurse

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Background Cardiac troponin I levels are often obtained to help rule out acute coronary syndrome. Objective To determine if elevation of troponin level within 24 hours for patients without acute coronary syndrome admitted to the intensive care unit provides important prognostic information. METHODS Patients without acute coronary syndrome admitted to the intensive care unit were prospectively divided into 2 groups according to highest serum level of cardiac troponin I within 24 hours of admission (elevated > 0.049 ng/mL; control ≤ 0.049 ng/mL). Hospital mortality, incidence of intubation, and other parameters were compared between the 2 groups. Results Patients with elevated troponin level (n = 40) had higher mortality than did control patients (n = 50) (35% vs 12%; P = .01). Compared with control patients, patients with elevated levels were more likely to be intubated (41% vs 17%; P = .02). Conclusion Critically ill patients without acute coronary syndrome with elevated levels of cardiac troponin I at admission had higher mortality and more intubations than did control patients.

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“…TNT has also been studied in patients undergoing CABG, including previous investigations by the authors of the current study, and elevated levels are associated with less favorable short and longer term outcomes. [3][4][5][6] In CABG patients, TNT levels may be elevated preoperatively as a result of acute coronary syndromes of varying severity and acuity. Even when preoperative levels are normal, as in many elective surgical patients, postoperative elevations of this sensitive biomarker occur as a result of cardiac incisions or manipulation, defibrillation, reperfusion, or myocardial injury from inadequate protection.…”

Section: Article See P 948mentioning

confidence: 99%