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Predicting adverse outcomes in elective coronary artery bypass graft surgery using pre-operative troponin I levels

Edward Buratto1, Paul Conaglen2, Jim Dimitriou3

  • 1Department of Cardiothoracic Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Australia.

Heart, Lung & Circulation
|April 15, 2014
PubMed

Insights

Pre-operative cardiac troponin I (cTnI) elevation in patients undergoing coronary artery bypass graft surgery (CABG) is linked to increased risks. Elevated cTnI may indicate higher 30-day mortality and cardiac arrest rates post-CABG.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pre-operative Assessment

Background:

  • Cardiac troponins are routinely measured before coronary artery bypass graft surgery (CABG).
  • The clinical significance of elevated cardiac troponin I (cTnI) in elective CABG patients is not well-defined.
  • This study examines the association between pre-operative cTnI levels and post-CABG outcomes.

Purpose of the Study:

  • To investigate the relationship between pre-operative cardiac troponin I levels and outcomes in patients undergoing elective CABG.
  • To determine if elevated cTnI predicts adverse events following CABG surgery.

Main Methods:

  • Prospective study of 378 patients undergoing isolated, elective CABG from 2010-2012.
  • Patients were stratified into normal (Group I) and elevated (Group II) pre-operative cTnI groups.
  • Pre-operative, operative, and post-operative data were collected from a prospectively maintained institutional database.

Main Results:

  • 12.4% of patients had elevated pre-operative cTnI.
  • No significant differences in intra-operative variables were observed between groups.
  • Elevated cTnI was associated with significantly higher 30-day mortality (6.4% vs 0.9%) and cardiac arrest rates (8.5% vs 1.5%).
  • Elevated cTnI remained an independent predictor of cardiac arrest in multivariable analysis (OR 5.8).

Conclusions:

  • Elevated pre-operative cTnI is common in patients undergoing elective CABG.
  • Patients with elevated cTnI face increased risks of 30-day mortality and cardiac arrest.
  • Routine pre-operative cTnI measurement can identify patients at higher surgical risk.
Abstract

Keywords:
CABGMyocardial ischaemiaOutcomesPre-operative careTroponin

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