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Relationship between elevated preoperative troponin T and adverse outcomes following cardiac surgery
William J Lyon1, Robert A Baker, Marie J Andrew
1Department of Cardiac Surgery, Flinders Medical Centre, Bedford Park, Adelaide, South Australia 5042, Australia.
Insights
Elevated preoperative troponin T (TnT) in cardiac surgery patients predicts higher mortality and longer hospital stays. This finding identifies high-risk individuals for complex recovery, guiding clinical management.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Troponin T (TnT) is a known prognostic marker post-myocardial infarction.
- Limited data exist on preoperative TnT's prognostic value in cardiac surgery.
- This study investigates preoperative TnT's utility in predicting recovery outcomes.
Purpose of the Study:
- To determine if elevated preoperative troponin T (TnT) predicts complex recovery in cardiac surgery patients.
- To assess the association between preoperative TnT levels and postoperative outcomes.
- To identify high-risk patient subgroups for enhanced perioperative care.
Main Methods:
- Assessed preoperative troponin T (TnT) in 696 patients undergoing coronary artery bypass graft surgery.
- Defined elevated TnT as ≥0.2 ng/mL.
- Prospectively recorded and retrospectively reviewed preoperative, intraoperative, and postoperative events.
Main Results:
- 10% of patients had elevated preoperative TnT.
- Elevated TnT significantly increased 30-day and 2-year mortality risk (ORs 6.7 and 5.0, respectively).
- Associated with prolonged ICU stays, longer hospitalization, increased cardiovascular support needs, and higher rates of congestive cardiac failure.
Conclusions:
- Elevated preoperative troponin T (TnT) identifies cardiac surgery patients at higher risk of morbidity and mortality.
- Preoperative TnT is an independent predictor of adverse outcomes.
- This marker can guide risk stratification and perioperative management.
Background:
The prognostic value of troponin T (TnT) has been demonstrated in patients following a myocardial infarction. There are limited data regarding the prognostic utility of preoperative TnT in patients undergoing cardiac surgery. The aim of the present study was to determine if elevated preoperative TnT is a predictor of more complex recovery outcomes in the cardiac surgical setting.
Methods:
A single preoperative TnT measurement was assessed in 696 patients undergoing isolated coronary artery bypass graft surgery. Elevated preoperative TnT levels were classified as > or =0.2 ng/mL. Preoperative, intraoperative, intensive care and postoperative events were prospectively recorded for all patients, and retrospectively reviewed for the present study.
Results:
Elevated preoperative TnT levels were detected in 10% (71/696) of patients. Compared to patients with normal TnT levels, elevated preoperative TnT increased the risk of mortality at 30 days (7% vs 1%, P = 0.004, odds ratio (OR) = 6.7) and 2 years (14% vs 3%, P < 0.001, OR = 5.0), and resulted in prolonged intensive care unit (ICU) stays (P < 0.001) and longer postoperative hospitalization (P < 0.001). Elevated preoperative TnT was also associated with an increased need for perioperative and postoperative cardiovascular support, early ischaemic change and postoperative congestive cardiac failure. In multivariate analyses preoperative TnT was a significant independent predictor of 30-day and 2-year mortality, and duration of ICU stay.
Conclusions:
Elevated preoperative TnT highlights a subgroup of cardiac surgical patients who are more likely to have a post-operative course with increased morbidity and mortality.