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Early Prognostic Value of High-Sensitivity Troponin T after Coronary Artery Bypass Grafting
Mauricio Nassau Machado1,2, Fernando Bruetto Rodrigues3, Ingrid Hellen Grigolo4
1Cardiac Surgery Intensive Care Unit, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, Brazil.
Insights
Elevated high-sensitivity troponin T (hsTnT) levels after coronary artery bypass grafting (CABG) are linked to increased 30-day mortality. Early detection of myocardial injury using hsTnT can help predict patient outcomes post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomarkers
Background:
- Periprocedural myocardial injury after coronary artery bypass grafting (CABG) can impact patient prognosis.
- Factors contributing to myocardial injury post-CABG may extend beyond atherosclerotic plaque instability.
- Diagnosing myocardial injury after CABG presents challenges.
Purpose of the Study:
- To investigate the association between early postoperative elevation of high-sensitivity troponin T (hsTnT) and 30-day all-cause mortality following CABG.
- To identify predictors of mortality in patients undergoing CABG.
Main Methods:
- A cohort of 600 consecutive patients undergoing CABG was studied.
- High-sensitivity troponin T (hsTnT) levels were measured pre-surgery and on the first postoperative day.
- Multivariate Cox proportional hazard analysis was employed to identify independent predictors of mortality.
Main Results:
- The median hsTnT level on the first postoperative day was 235 ng/L.
- A higher postoperative hsTnT ratio to the upper reference limit was a significant predictor of mortality (HR=1.06).
- Age was also identified as an independent predictor of 30-day mortality (HR=1.13).
Conclusions:
- Elevated postoperative hsTnT levels are reliable predictors of all-cause 30-day mortality after CABG.
- Patient age is another independent predictor of 30-day mortality post-CABG.
- These findings highlight the importance of monitoring hsTnT for risk stratification in CABG patients.
Background:
Periprocedural myocardial injury after coronary artery bypass grafting (CABG) may affect the patient's prognosis and may be due to a different set of factors beyond the atherosclerotic plaque instability. Considering the challenges in the diagnosis of myocardial injury after CABG, the aim of this study was to determine the association between postoperative early elevation of high-sensitivity troponin T (hsTnT) and all-cause 30-day mortality after CABG.
Methods:
We enrolled 600 consecutive patients who underwent CABG. The hsTnT value was measured immediately before surgery and in the morning of the first postoperative day.
Results:
The baseline hsTnT was 13 ng/L (7-26 ng/L) and 273 patients (45.7%) had baseline hsTnT above the 99th percentile/upper reference limit (URL) (14 ng/L). The median for hsTnT at first postoperative day was 235 ng/L (152-425 ng/L). We calculated the postoperative hsTnT ratio to URL for each patient, representing the number of times exceeding the URL (hsTnT value divided by 14 ng/L). The multivariate analysis by Cox proportional hazard model revealed that age (years) (hazard ratio [HR] = 1.13, 95% confidence interval [CI]: 1.07-1.20; p < 0.001) and postoperative hsTnT ratio to URL (per 10-fold increase) (HR = 1.06, 95% CI: 1.04-1.08; p < 0.001) were independent predictors of all-cause 30-day mortality after CABG.
Conclusion:
In our series, age and higher postoperative hsTnT levels were independent and reliable predictors of all-cause 30-day mortality after CABG.
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