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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Prognostic Value of Early Postoperative Troponin T in Patients Undergoing Coronary Artery Bypass Grafting
Brigitta Gahl1, Volkhard Göber1, Ayodele Odutayo2
1Department for Cardiovascular Surgery, Inselspital, Bern University Hospital University of Bern, Switzerland.
Insights
Post-coronary artery bypass grafting, elevated cardiac troponin T (cTnT) levels 6-12 hours after surgery predict major adverse cardiac or cerebrovascular events (MACCE). This finding aids in identifying high-risk patients for better outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Cardiac troponin T (cTnT) levels rise after coronary artery bypass grafting (CABG) surgery.
- The clinical significance of these elevations for in-hospital outcomes requires further investigation.
Purpose of the Study:
- To determine the association between cTnT levels 6-12 hours post-CABG and in-hospital outcomes.
- To evaluate the prognostic performance of both conventional and high-sensitivity cTnT (hs-cTnT) assays.
Main Methods:
- Prospective study of 1722 patients undergoing isolated CABG.
- Assessed conventional cTnT (749 patients) and hs-cTnT (973 patients) 6-12 hours postoperatively.
- Evaluated major adverse cardiac or cerebrovascular events (MACCE) and a composite safety outcome.
Main Results:
- Elevated cTnT levels were associated with increased odds of MACCE and safety composite events.
- Both conventional and hs-cTnT showed moderate discrimination for MACCE and safety outcomes.
- A cTnT cutoff of 800 ng/L demonstrated clinical relevance for ruling in adverse events.
Conclusions:
- Postoperative cTnT levels measured 6-12 hours after CABG are valuable predictors of MACCE and other complications.
- These findings support the use of cTnT as a prognostic marker in the early postoperative period following CABG.
Background:
Cardiac troponin T (cTnT) is elevated after coronary artery bypass grafting surgery. The aim of this study was to determine the association between cTnT elevations between 6 and 12 hours after coronary artery bypass grafting and in-hospital outcome.
Methods And Results:
We prospectively studied 1722 patients undergoing isolated coronary artery bypass grafting. We assessed the association between conventional cTnT (749 patients) and high-sensitivity cTnT (hs-cTnT; 973 patients) 6 to 12 hours postoperatively with in-hospital major adverse cardiac or cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, or stroke. The prespecified secondary outcome was a safety composite of MACCE, resuscitation, intensive care unit readmission or admission ≥48 hours, inotrope or vasopressor use ≥24 hours, or new-onset renal insufficiency. Among patients with a conventional cTnT measurement, 92 experienced a MACCE (12%) and 146 experienced a safety composite event (19%). Likewise, for hs-cTnT, 114 experienced a MACCE (12%) and 153 experienced a safety composite event (16%). Compared with cTnT ≤200 ng/L, each 200-ng/L increment in cTnT was associated with a monotonous increase in the odds of MACCE and the safety composite outcome. Conventional and hs-cTnT demonstrated moderate discrimination for MACCE (areas under the fitted receiver operating characteristics curve, 0.72 and 0.77 for conventional and hs-cTnT, respectively) and the safety composite outcome (areas under the fitted receiver operating characteristics curve, 0.66 and 0.74 for conventional and hs-cTnT, respectively) and resulted in improved prognostic performance when added to the EuroSCORE. At a cutoff of 800 ng/L, conventional and hs-cTnT provided clinically relevant power to rule in MACCE and the safety composite outcome.
Conclusions:
cTnT levels assessed between 6 and 12 hours after coronary artery bypass grafting identify patients at increased risk of MACCE or other complications.
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