Value of Early Cardiac Troponin I to Predict Long‐Term Adverse Events After Coronary Artery Bypass Graft Surgery in Patients Presenting with Acute Coronary Syndromes

Abstract

Background High values of both preoperative and postoperative cardiac troponin I (cTnI) contribute to higher rates of short‐term cardiac events following coronary artery bypass graft (CABG) surgery in patients with acute coronary syndrome (ACS). The prognostic value of very early cTnI in this context is unclear. Hypothesis Measurement of cTnI very early after admission to the emergency room can be used as a prognosticator for long‐term outcomes after CABG. Methods We conducted a cohort study on 160 consecutive patients with ACS undergoing CABG at The John H. Stroger Jr. Hospital of Cook County (Chicago, IL) representing a total follow‐up of 290.42 person‐years. Adverse outcomes were defined as death or reinfarction. We used robust multivariate survival analyses to determine whether early cTnI measurement can independently predict the adverse outcomes in the study subjects. Results In univariate and stepwise multivariate Cox proportional hazards modeling we found that unit rise in early cTnI is associated with a 3% (95% confidence interval [CI]: 2%− 5%, p < 0.001) faster progression to long‐term adverse events after CABG even after adjusting for the type of ACS. Prognostically, the most informative cut off value for cTnI was 5.6 ng/mL. Above this value, CABG patients progressed 2.58 times faster to adverse outcomes (95% CI: 1.05–6.36, p = 0.039). This effect remained after adjustment for other significant confounders namely, poor compliance to medications, female sex, Medicaid insurance, and electrocardiographic ischemia. Conclusion Early cTnI measurement after admission can predict adverse outcomes after CABG. This association extends to long‐term adverse events after CABG. Copyright © 2009 Wiley Periodicals, Inc.

The Extent of Coronary Atherosclerosis Is Associated With Increasing Circulating Levels of High Sensitive Cardiac Troponin T

“…The detection of myocardial injury is an important step in making the clinical decision to admit patients with chest pain to the coronary care unit. Studies evaluating the clinical value of cTnT were performed in patients with unstable angina pectoris 20,21 and patients who underwent coronary artery bypass grafting 22 or percutaneous coronary intervention. 23 These studies unequivocally demonstrated that elevated levels of cTnT are associated with poorer prognosis In patients without CAD, 41% had hs-cTnT values in the lowest quartile, compared with 12% in the multivessel group.…”

Emergency Cardiac Biomarkers and Point-of-Care Testing

“…Table 5 summarizes literature published since 20005,10-37 where investigators studied POC cardiac biomarker testing in emergency and disaster settings. Evidence-based results are varied, most probably because of lack of a uniformly systematic approach to the implementation and use of a variety of POC devices, as well as the heterogeneous test clusters employed in dissimilar environments.…”

Timing of coronary artery bypass surgery in patients with non-ST-segment elevation myocardial infarction and postoperative outcomes

“…The roles of cardiac troponins in predicting the preoperative and postoperative mortality and morbidity have been demonstrated in various studies [9][10][11]. Filizcan et al [14] showed that cardiac troponin levels were one of the predictive factors for hospital mortality in AMI patients with ST-segment elevation.…”

“…Diagnosing patients with ACS and determining their treatment alternatives provide valuable information on the prognosis of these patients [9,10]. There are numerous studies which have shown an association between high preoperative and postoperative troponin levels associated with increased morbidity and mortality rates in patients undergoing CABG [11][12][13][14]. This raises the possibility that cardiac troponin levels may be used as a marker for the timing of CABG operations.…”